Healthcare delivery is complex and difficult to navigate for patients, providers, and pharmacists. A system-of-systems perspective to integrate all key players (patients, providers, pharmacists) is used to evaluate information flow paths and coordination used in the outpatient medication process. Rather than substituting electronic prescribing for the current prescription process, this study evaluates the communication paths in a multi-modal information flow model. With multiple paths available to prescribe a medication, this research developed an information flow model between patients, providers, and pharmacists based on prescription type (new, refills, and renewal). A taxonomic classification was applied to the observed information flow models based on information and communication technology (ICT) mediation and feedback between key players.

 

This research focused on the preference of the patients, providers, and pharmacists for each information flow path based on prescription types. E-prescribing was the preferred path for new prescriptions among all participants. However, there was significant difference between providers and pharmacists for phone and voicemail prescriptions and a significant different between providers, pharmacists and patients for faxed prescriptions. For refill and renewal prescriptions, the patient was identified as the key player responsible for initiating these prescription types.

 

Misalignments between federal mandates and actual use of e-prescribing systems were emphasized such as the lack of two-way communication and lack of fill status notification. Additionally, the patient was expected to initiate the renewal prescription, which conflicts with the benefit of e-prescribing systems to facilitate the renewal process. Another finding that emerged was the variability within the new prescription process based on information flow path. Based on this variability within the new prescription process, event management definitions that apply to the outpatient prescription process were outlined.