Implementing an Ambulatory e-Prescribing System: Strategies Employed and Lessons Learned to Minimize Unintended Consequences

Electronic health records are thought to improve quality of care; computerized provider order entry (CPOE) systems are believed to reduce medication errors. Yet, research suggests that implementation of new technologies revises existing sociotechnical systems and introduces unpredicted and unintended consequences, including the generation of new types of errors. We narrate development and implementation of a CPOE system—specifically a homegrown, e-prescribing system—in a community-based, integrated health care system. We describe the strategies used and lessons learned that enabled successful adoption: buy-in starts at the top of the organization; ongoing communication is key; a team-oriented culture is critical to success; iterative implementation is a useful strategy; ongoing and readily accessible training is necessary; involvement of clinicians achieves buy-in and contributes to ongoing improvements; and workflow redesign is an integral facet of implementation. These strategies and lessons were used to minimize unintended consequences and to maximize the potential of e-prescribing technology to improve medication safety.