JMIR Publications

ABSTRACT

Background:

Electronic prescription systems are supported by health authorities worldwide, and most European countries have started implementing or have fully implemented such systems. However, few studies have explored how electronic prescription systems affect the work of healthcare professionals across the institutional and administrative levels of national healthcare services.

Objective:

This study explores changes in health professionals' roles, tasks, and responsibilities related to medication management by following a national e-prescription system through different contexts and levels in health and care services.

Methods:

Through an ethnographic approach, including participant observations and individual interviews, this study followed an e-prescription technology in an intermediate unit, an emergency unit at a hospital, and a municipal home care service in Norway. A total of six weeks of participant observation was conducted in the intermediate unit, the emergency units at the hospital, and the home care services. During the observations, 21 individual interviews with health professionals were conducted. For the analysis, we leaned on a stepwise deductive inductive approach, using the concepts of delegation (from Latour) and enabler (from Allen) as theoretical tools to explore how roles, tasks and responsibilities were being distributed within the sociotechnical system of which e-prescription forms part.

Results:

Two themes were recurring in the data material: the involved actors did a lot of work to achieve the goal of an efficient workflow, and human actors had to facilitate the environments for the technology to work in accordance with expectations and demands for maximum patient safety. We observed that medical doctors were overall satisfied with the e-prescription system and expressed satisfaction that some of their previous tasks were now delegated to the e-prescription system, allowing for a more efficient workflow on their side. On the other hand, the home care service managing medication on their patient's behalf described several challenges and increased work related to medication management. Homecare nurses often became mediators between the GPs and the pharmacies to ensure patient safety. The home care nurses also developed e-prescription-based workarounds to enable the e-prescription system to work.

Conclusions:

The study revealed that the e-prescription systems altered daily medication management routines, removing tasks from medical doctors and creating and delegating new roles, tasks, and responsibilities to homecare nurses. Drawing on theoretical concepts from Latour and Allen (delegation and enabler), this study offers insights into the changing distribution of role, tasks and responsibilities following in the wake of implementing national e-prescription systems. The study emphasizes the importance of research following digital systems across various contexts to understand the larger picture of their effects on healthcare professionals' work. Our findings shed light on complexities and challenges associated with e-prescription systems in healthcare settings that deserve attention in future planning and systems development.