The Use of Process and Simulation Modeling to Inform the Design of Electronic Prescribing Systems

Abstract

<p>Objectives: (1) to assess whether computer simulation modeling or process modeling have improved medication management systems, including informing the design of e-prescribing systems for Canada, and (2) to build and validate a workflow diagram of the handwritten medication management process in the community setting for Canada and use it to obtain feedback from stakeholders.</p> <p>Methods: A systematic review was conducted to assess whether the modeling techniques have improved medication management systems. A workflow diagram was developed and used to obtain feedback from stakeholders as to where problems exist in the current paper-based process and where information technology might be of help. Analyses were descriptive and qualitative.</p> <p>Results: The systematic review identified 13,376 citations, 8 of which were included in the full data extraction. The review revealed that simulation models of e-prescribing systems have been developed, but their accuracy and usefulness has not been established. One process model had been used to analyze a Canadian medication management system, but no evidence was found that process models had any positive impact on e-prescribing development in Canada.</p> <p>Fifteen stakeholders, including 5 physicians, 5 pharmacists, and 5 members of the public provided feedback using the workflow diagram. All stakeholders agreed that the diagram was a realistic representation of the actual handwritten medication management process, suggesting face validity. The majority of stakeholders identified the most problematic processes as generating the prescription by the physician (9/15 (60.0%)) and drug checking by the physician (6/15 (40.0%)).</p> <p>Conclusions: There is a lack of published evidence on simulation models and process models, and the studies that exist do not suggest any benefit in informing e-prescribing design. We developed and established face validity for a workflow diagram of the paper-based medication management cascade. Stakeholders believed that generating the prescription and drug checking by the physician could be improved by e-prescribing.</p>