A survey of E-Prescription readiness in selected Nigeria Hospitals
©2014
Textbook
55 Pages
Summary
This project aims to survey electronic prescription readiness in Nigeria hospitals to know whether they are ready for electronic prescription or not. Electronic prescribing or e-prescribing is a computer-based electronic generation and transmission of a prescription. Prescribing systems help to increase patient safety and increase prescribing accuracy, the system also helps to reduce costs through improved legibility. The motivation for e-prescribing lies in the greater safety of drug use and the current unacceptable levels of adverse drug events. The aim of this study is to evaluate the readiness of Hospitals in Nigeria to adopt e-prescription system for patient’s welfare and improved healthcare service delivery. With the adoption of e-prescription, errors in writing prescriptions that sometimes result in patient’s harm could be rectified.
Excerpt
Table Of Contents
VIII
2.7 Review of related work ... 24
2.8 Concluding remarks ... 27
CHAPTER THREE: METHODOLOGY ... 28
3.1 Introduction ... 28
3.2 Survey development ... 28
3.3 Survey implementation ... 29
3.4 Data collection instrument ... 29
3.5 Matlab overview ... 30
3.6 The matlab language ... 30
3.7 Data analysis ... 31
CHAPTER FOUR: ANALYSIS AND INTERPRETATION
OF RESULT ... 34
4.1 Introduction ... 34
4.2 Frequency distribution table of demographic ... 34
4.3 RESPONDENTS ... 52
4.4 ECONOMICFEASIBILITY ... 52
4.5 TECHNICAL FEASIBILITY ... 53
4.6 ORGANIZATIONAL FEASIBILITY ... 53
CHAPTER FIVE: CONCLUSION AND RECOMMENDATION .. 54
5.1 Conclusion ... 54
5.2 Recommendation ... 54
REFERENCES ... LV
IX
LIST OF TABLES
TABLE 2.1 Difference between paper prescription and e-prescription ... 18
TABLE 4.1 Frequency distribution table of gender ... 34
TABLE 4.2 Frequency distribution table of profession ... 34
TABLE 4.3 Frequency distribution table of age ... 35
TABLE 4.4 Frequency distribution table of year in practice ... 36
TABLE 4.5 Test statistic table for economic feasibility ... 36
TABLE 4.6 Frequency distribution table of respondent on internet network improvement ... 37
TABLE 4.7 Frequency distribution table of respondent on if e-prescription will
improve quality of service ... 38
TABLE 4.8 Frequency distribution table of respondent on if e-prescription saves time ... 39
TABLE 4.9 Frequency distribution table of respondent on if hospital affordability of
computers to physicians ... 40
TABLE 4.10 Test statistic table of technical feasibility ... 41
TABLE 4.11 Frequency distribution table of respondent on internet network qualities ... 41
TABLE 4.12 Frequency distribution table of respondent on ability to operate computer ... 42
TABLE 4.13 Frequency distribution table of respondent on response to training ... 43
TABLE 4.14 Frequency distribution table of respondent on e-prescription ease of use ... 43
TABLE 4.15 Frequency distribution table of respondent on ability to use computer ... 44
TABLE 4.16 Test statistic table of organizational feasibility ... 45
TABLE 4.17 Frequency distribution table of respondent on government response to
hospital needs ... 45
TABLE 4.18 Frequency distribution table of respondent on how long hospital can
manage e-prescription ... 47
TABLE 4.19 Frequency distribution table of respondent on hospital readiness to
adopt e-prescription ... 48
X
TABLE 4.20 Frequency distribution table of respondent on patient readiness to
adopt e-prescription... 49
TABLE 4.21 Average mean score table ... 50
TABLE 4.22 Correlation table ... 51
XI
LIST OF FIGURES
FIG 2.1 Stages for creating and managing a prescription electronically. ... 22
FIG 4.1 Frequency distribution pie chart of profession ... 35
FIG 4.2 Frequency distribution pie chart of respondent on internet network improvement ... 37
FIG 4.3 Frequency distribution pie chart of respondent on if e-prescription will
improve quality of service ... 38
FIG 4.4 Frequency distribution pie chart of respondent on if e-prescription saves time ... 39
FIG 4.5 Frequency distribution pie chartof respondent on if hospital affordability of
computers to physicians ... 40
FIG 4.6 Frequency distribution pie chartof respondent on internet network qualities ... 42
FIG 4.7 Frequency distribution pie chart of respondent on e-prescription ease of use ... 44
FIG 4.8 Frequency distribution pie chart of respondent on government response to
hospital needs ... 46
FIG 4.9 Frequency distribution pie chart of respondent on how long hospital can
manage e-prescription ... 47
FIG 4.10 Frequency distribution pie chart of respondent on hospital readiness to
adopt e-prescription ... 48
FIG 4.11 Frequency distribution pie chart of resp0ndent on patient readiness to
adopt e-prescription ... 49
XII
ABSTRACT
This project is to survey electronic prescription readiness in Nigeria hospitals to know whether
they are ready for electronic prescription or not. Electronic prescribing or e-prescribing, is
computer-based electronic generation and transmission of a prescription. Prescribing systems
helps to increase patient safety and increases prescribing accuracy, the system also helps to
reduce costs through improved legibility. The motivation for e-prescribing is greater safety of
drug use and the current unacceptable levels of adverse drug events. The aim of this study is to
evaluate the readiness of Hospitals in Nigeria to adopt E-Prescription system for patient welfare
and improved healthcare service delivery. With this research, problem of writing prescription for
patients, which are prone to errors and sometimes result in patient harm, could be rectified if e-
prescription is adopted.
A survey was conducted in Nigeria hospitals, which includes Lagos state university teaching
hospital (LASUTH), University of Lagos teaching hospital (LUTH), Federal medical center
(FMC Abeokuta) and The Neuropsychiatric hospital, Aro, Abeokuta. A well-structured question-
naire was also developed and was given out to doctors, pharmacists, pharmacy technicians and
assistants present at the time of survey administration. Analysis of data was surveyed using
MATLAB/Spss for analyzing of closed-ended questions; data was analyzed by using descriptive
statistics, chi-square test and correlation co-efficient.
From the result of the analysis, it shows that EP system implementation is economically feasible
on the side of an individual but on government side adequate funding for the achievement of EP
system does not provide for the health sector to acquire the necessary resource and training skill.
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CHAPTER ONE
INTRODUCTION
1.1 Background of the study
The major challenge of all health systems is to maximize the quality and the quantity of activities
related to development or at least stabilization of health status of citizens, this maximization and
optimization is often subject to budgetary and other constraints (EU, 2006).
Improvement in information and communication technology, being used in the Healthcare sector,
are expected to be the solution for the reduction of rapidly increasing cost and the improvement
of poor quality of healthcare services.
Medication prescribing is examined to be one of the most frequently used, powerful, therapeutic
tools available to physicians. According to the definition provided by the e Health Initiative
(EHI) electronic prescribing refers to "the use of computing devices to enter, modify, review and
output or communicate drug prescriptions". (Perdikouri and Katharaki, 2011). Electronic pre-
scribing has been proposed as an important strategy to reduce medication errors, improve the
quality of patient care and create savings in healthcare costs (Tan et al, 2009) Electronic prescrib-
ing systems helps to increase patient safety and reduce costs through improved legibility since the
misinterpretation of poorly handwritten prescriptions is the most frequently identified causes of
medication errors. (Stranges et al, 2008). Despite the advantages of electronic prescribing the
survey is to determine whether hospitals, pharmacists and physicians are ready for e-prescription,
human factors could play a significant role in the success of the new technology and user
satisfaction is one of them, from the view of physicians and pharmacists, changes to workflow,
familiarization with the technology, and time commitment may overshadow the potential benefits
of electronic prescribing. (Tan et al,2009) Therefore to ensure successful implementation of the
system, implementers should frequently monitor areas of satisfaction and dissatisfaction among
users, our survey is to determine the rate of how users are ready for e-prescription.
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1.2 Statement of problem
Prescription of medications are among the most commonly used treatment in health care, but the
process of managing written prescriptions and related telephone messages consumes substantial
time for prescribers and their staff. Furthermore, these processes are prone to error and miscom-
munication, which sometimes result in patient harm. Electronic prescribing has been proposed as
an important strategy to reduce medication errors, improve the quality of patient care and create
savings in healthcare costs (Tan et al, 2009)
Many barriers have hindered the adoption of EHRs and e-prescribing systems, including the
misalignment of financial incentives, the high cost of purchase, implementation and maintenance
of systems; the immaturity of software products and vendors; the lack of integration between
EHR systems;(Ash and Bates, 2005)and physician resistance.
A survey conducted by the Massachusetts Medical Society in 2003 revealed a large gap between
physicians' perceived value of e prescribing and their intent to adopt this practice.(Ash and Bates,
2005)Their reluctance to embrace the changeover from paper to computerized systems was
based, in large part, on the perception that e-prescribing is time-inefficient.
1.3 Motivation
E-prescribing systems have the potential to greatly reduce adverse pharmaceutical effects
deriving from transcription, drug-drug interaction, allergies and dosage errors, to name a few.
Indeed, studies show significant improvements associated with e-prescribing implementation,
including an 86% decrease in serious medication errors and an increase in Medicare formulary
adherence from 14% to 88%. (Speaker and Audet ,2006). Despite this evidence, however,
providers have been slow to adopt e-prescribing technology due mainly to cost and regulatory
constraints in the health industry.
According to the U.S. Department of Health and Human Services (HHS), while most industries
spent $8,000 per worker for IT in the last decade, the health care industry invested only $1,000
per worker. (HR Policy Association, 2006). It should be noted that e-Prescription yields a variety
of benefits of to patients, physicians and third parties (Petropoulou et al, 2011):
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1.4 Aim
The aim of this study is to evaluate the readiness of Hospitals in Nigeria to adopt e-Prescription
System for
patient welfare and improved healthcare service delivery
1.5 0bjectives
1.
Carry out extensive literature review on related works on e-prescription adoption
2. To ascertain the acceptance level of e-prescription systems
3.
To make recommendations based on findings
1.6 Methodology
This study was conducted in Nigeria hospitals; a survey questionnaire was developed after
reviewing the literature and interviewing doctors and Pharmacists in the respective institutions.
The
survey questions addressed demographic information, experience in healthcare, experience
with computers, and experience using an electronic prescription system. In addition to collecting
information about the respondents, the survey also covers functionality, user training and support,
and overall satisfaction.
Part of our preparation used to conduct the survey was a literature review and research. Academic
journals, presentations, information materials, slides were also used to prepare for our study.
Using these materials, we built a better understanding of the study. Majority of the materials we
studied can be categorized in to some of the following: academic publications on assessment of
electronic prescription systems, academic publications on satisfaction and adoption rate of
electronic prescriptions systems.
A cross-sectional survey was conducted at each hospital and a
hardcopy self-administered anonymous questionnaire was given out to doctors, nurses, pharma-
cists and other medical practitioners. The completed form was collected by hand. Analysis of
data was done using
a computer programme called MATLAB was used. Data was analysed by
using descriptive statistics, frequency distribution was drawn and also chi-square hypothesis test
of Non-parametric is employed, to test for the significant of the three variables economic feasibil-
ity, technical feasibility and organizational feasibility of E-prescription system.
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1.7 Significance of study
Problem of writing prescription for patients, which are prone to errors and sometimes result in
patient harm, with this research the problem could be rectified if e-prescription is adopted.
This research would also let us know if the physician, patients and pharmacist are ready for the e-
prescription or not.
1.8 Scope
The survey was conducted in Nigeria hospitals, which include Lagos state university teaching
hospital (LASUTH), University of Lagos teaching hospital (LUTH), Neuropsychiatric hospital,
Aro, Abeokuta and Federal Medical Center Abeokuta.
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CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
Paper prescriptions have been in use over the past year, written prescription became the sold
means of communication between the physician and pharmacist. However they were drawbacks
in this system, written prescription situation becomes even more complicated. The vision for
electronic prescription systems was born in order to solve this problem and health informatics
experts at the time thought that electronic prescription would be adopted in health industry within
a few years, few dispute that e-prescription will improve the safety, quality and efficiency of
patient care but low adoption rate persist. In this chapter, the review starts by defining e-
prescription and describing its functionalities. Then the issues existing in paper prescription
system. Next, review of related work from the perspectives of developed and developing coun-
tries.
2.2 E-Prescribing
Electronic prescribing has been proposed as an important strategy to reduce medication errors,
improve the quality of patient care and create savings in healthcare costs (Woan et al,
2009).Electronic prescription systems allow the prescribing clinician to electronically send an
accurate, error-free and understandable prescription directly to the pharmacy. E-Prescribing is the
use of healthcare technology to improve prescription accuracy, increase patient safety and reduce
costs, as well as enable secure, bi-directional, electronic connectivity between physician practices
and pharmacies. This is achieved by providing prescribers a secure means of electronically
accessing up-to-date health plan formulary, patient eligibility and medication history at the point
of care and securely transmitting the prescription electronically into the pharmacy's computer
system. (Rxhub, 2008).
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2.2.1. E-prescription and paper prescription system
With the definition of e-prescription defined earlier, essential differences between e-prescription
system and paper system which is also known as the traditional system, patients visit their health
care provider for medical consultation, and after assessment of the medical condition of the
patient the doctor writes off a prescription on a paper. The prescription is then signed and given
to the patient, then the patient authorized representative presents the prescription to a pharmacy
of his/her choice for getting the prescribed medicines while the electronic prescription which is
the transmission and processing of medical information contained within medicinal prescriptions
through all components of the prescription system, from the initial prescribing of the drugs,
through dispensation to the patient, to the eventual close of transaction at some prescription-
processing agent.
Table 2.1 Difference between paper prescription and e-prescription
Paper system
e-prescription system
High rate of prescription fraud
Low rate of prescription fraud
High rate of prescription error
Low rate of error prescription
Due to error, it increase cost
It saves cost
Highly susceptible to adverse drug effect
Low adverse drug effect
2.2.2 Issues of paper prescription
Today most medical prescriptions are typically handwritten or printed on paper and hand-
delivered to pharmacists. Paper-based medical prescription has generated and still generating
major concerns as the incidences of prescription errors have been increasing and causing prob-
lems to patients, including deaths. Though paper prescription system has been in existence for
years, it is easily influenced for different types of errors at each step in the process. These errors
are the result of difficulties such as
19
I.
Lack of medical information integrity and sharing
II.
Drug cross-reactivity and complications
III.
Incorrect or inadequate physicians knowledge about the new medications
IV.
Slow prescription ordering and dispensing process
V.
Security and privacy issues
VI.
Lack of standardization of technologies and protocols used
VII.
Administrative and organizational issues such as pharmaceutical benefits and billing pro-
cess.
Fatal health problems can arise due to bad and illegible written prescriptions, errors in dosage and
unanticipated drug interactions, communication errors committed during ordering, dispensing
and administering of drugs, and dosing mistakes such as incorrect dose of drug and incorrect
frequency of drug intake, and lack of reliable health information. Most of these errors of paper
prescription system could be reduced by electronic prescription. Though e-prescription is simple
and straightforward, it has not yet been widely adopted.
2.2.3 Types of an e-Prescribing system
There are two choices of an e-prescribing system; it is either a stand- alone system, or e-
prescribing within an EHR system. There are pros and cons of each option in terms of cost, level
of effort and time to select and deploy, impact on practice workflow and productivity initially and
over time, and interoperability with other electronic health information systems.
2.2.3.1 A stand-alone system is less costly and less difficult to implement, and thus can be
implemented faster than an EHR system. This may be an important consideration for practices
that wish to be eligible for Medicare's e-prescribing bonus that begins on January 1, 2009. E-
prescribing systems store and manage patient data specific to the prescribing process (e.g.,
medication history, medication allergies, etc.). E-prescribing software is offered in two forms: (a)
a software package you acquire and download to your office computer system, or more common-
ly; (b) through the Internet, connecting with an e-prescribing software application service
provider (ASP), to whom you pay usage fees.
In terms of e-prescribing hardware, physician practices have many choices including: hand- held
devices, tablet personal computers, desktop personal computers, and other hardware made
available by technology vendors.
Details
- Pages
- Type of Edition
- Erstausgabe
- Publication Year
- 2014
- ISBN (eBook)
- 9783954897988
- ISBN (Softcover)
- 9783954892983
- File size
- 617 KB
- Language
- English
- Publication date
- 2014 (June)
- Keywords
- e-prescription nigeria hospitals
