J Am Med Inform Assoc 17:425-431 doi:10.1136/jamia.2009.001826
  • Research paper

Technological viewpoints (frames) about electronic prescribing in physician practices

  1. Michael A Fischer4
  1. 1Center for Health Information and Decision Systems, Robert H. Smith School of Business, University of Maryland, College Park, Maryland, USA
  2. 2Department of Management, Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana, USA
  3. 3Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Corey M Angst, Department of Management, Mendoza College of Business, University of Notre Dame, Notre Dame, IN 46556, USA; cangst{at}
  • Received 21 May 2009
  • Accepted 21 March 2010


Objective Physician practices may adopt and use electronic prescribing (eRx) in response to mandates, incentives, and perceived value of the technology. Yet, for the most part, diffusion has been limited and geographically confined, and even when adopted, use of eRx in many practices has been low. One explanation for this phenomenon is that decision-makers in the practices possess different technological viewpoints (frames) related to eRx and these frames have formed the basis for the adoption decision, expectations about the technology, and patterns of use. In this study eRx technological frames were examined.

Design Focus groups, direct observation, and semi-structured interviews were conducted with physicians, practice managers, nurses, and other medical staff.

Measurements Focus groups were observed, taped, transcribed, and analyzed to reveal themes. These themes guided the observational visits and subsequent interviews. A triangulation process was used to confirm the findings.

Results Seven frames emerged from the qualitative analysis ranging from positive to neutral to negative: (1) eRx as an efficiency and effectiveness enhancing tool; (2) eRx as the harbinger of new practices; (3) eRx as core to the clinical workflow; (4) eRx as an administrative tool; (5) eRx: the artifact; (6) eRx as a necessary evil; and (7) eRx as an unwelcome disruption.

Conclusion Frames provide a unique perspective within which to explore the adoption and use of eRx and may explain why perceptions of value vary greatly. Some frames facilitate effective use of eRx while others impose barriers. Electronic prescribing can be viewed as a transitional technology on the path to greater digitization at the physician practice level. Understanding the impact of technological frames on the effectiveness of eRx use may provide lessons for the implementation of future health information technology innovations.


  • Funding This study was funded by a grant from the Agency for Healthcare Research and Quality, # R18 HS017151-01.

  • Competing interests None.

  • Ethics approval The project was approved by institutional review boards at the University of Maryland and Brigham and Women's Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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