E-prescribing System Research Articles

Developing, applying and measuring an e-Prescription Information Systems Success Model from the persperctives of physicians and pharmacists

This study aims to empirically test an e-prescription success model with 8 constructs consisting of Information Quality, System Quality, Service Quality, Social Impact, Facilitating Conditions, Use Dependency, User Satisfaction and Net Benefit. A total of 254 participants including physicians and pharmacists in 3 different provinces of Turkey were included in the study group by simple random sampling method. Measurement instrument was found to be reliable. SPSS 19 package was used to determine construct validity of the model and AMOS 22 software was used to determine model data fit after explanatory factor analysis. CFA showed that fit indices of the model were within the desired intervals. The success model developed was tested using correlation and regression analyses to determine the relationship between the observed variables. It was found that the pharmacists and physicians were moderately satisfied with the e-prescription system and there was no statistically significant difference between their total scores for perceived Net Benefit. Facilitating Conditions for the system and Social Impact had a significant impact on User Satisfaction. It was found that Use Dependency and User Satisfaction were important predictors of Net Benefit. It can be stated that User Satisfaction and indirectly Net Benefit of e-prescription system will increase when Facilitating Conditions are created for the users.

Opportunities to improve antimicrobial use in paediatric intensive care units: a nationwide survey in Spain

Improving antimicrobial use is a complex process that requires an accurate assessment of ongoing problems and barriers. Paediatric intensive care units (PICU) have seldom been assessed from this perspective. Two Internet-based, self-administered surveys were conducted nationwide in Spain between January and February 2014. The first survey aimed to assess those characteristics of Spanish PICUs that could influence antimicrobial prescribing or antimicrobial stewardship. The second survey targeted Spanish PICU physicians and pursued to assess their attitudes and perceptions regarding antimicrobial resistance and antimicrobial use. Information about 29/39 contacted PICUs was obtained. A total of 114/206 (55.3%) paediatric intensivists responded. PICUs were heterogeneous regarding years since foundation, number of beds, type of patients admitted and staffing. Only 11 (37.9%) PICUs had available e-prescribing systems. Procalcitonin was available in 24 (89.1%) PICUs, but there were no procalcitonin-based protocols in 14 (60.9%) of them. Half of surveyed PICUs had implemented antimicrobial stewardship activities. Ninety-eight of the 114 PICU physicians (86%) who participated considered that antimicrobial resistance was a significantly relevant problem for their daily and that improving antimicrobial use in their PICU should be a priority (103; 90.4%). The main perceived problems regarding antimicrobial use were the excessive use of antimicrobials in patients with nonconfirmed infections and excessive use of broad-spectrum antimicrobials. The most valued antimicrobial stewardship interventions were the implementation of protocols to guide antimicrobial therapy. Spanish PICU doctors are aware of the relevance of the problem of antimicrobial resistance and the need to improve antimicrobial use. Targeted interventions should take into account their difficulties and preferences when feasible.

The impact of electronic prescribing systems on pharmacists’ time and workflow: protocol for a time-and-motion study in English NHS hospitals

IntroductionElectronic prescribing (ePrescribing) systems are rapidly being introduced into National Health Systems (NHS) hospitals in England following their widespread earlier adoption into primary care settings. Such systems require substantial changes...

Election 2015: Communicating pharmacy's priorities.

Canadians will be heading to the polls in a federal election widely expected to occur October 19, 2015. Although the pundits would argue that political parties have been campaigning for months already, most election-related activities, such as public debates and door-to-door campaigning by candidates, will begin to ramp up in late summer and fall. As the 2015 federal election campaign moves into high gear, the Canadian Pharmacists Association (CPhA) has identified key recommendations and messages for federal political candidates on 3 key national issues of importance to the profession. These 3 issues include the following: Pan-Canadian Pharmacare Program: CPhA is seeking commitment from all federal political parties to work with the provinces/territories, health care professionals and other stakeholders towards the development of a pan-Canadian pharmacare program. Such a program must address coverage gaps between public and private systems, protect Canadians from undue financial hardship and guarantee access to a stable supply of clinically and cost-effective medications. Furthermore, the inclusion of access to pharmacy services under a pharmacare model is key to achieving better health outcomes and cost savings. National Plan for e-Prescribing: CPhA is calling on all parties to work with the provinces/territories, health care professionals and other stakeholders to implement a seamless e-prescribing system in Canada. CPhA is looking for the federal government to support the development and implementation of a common national standard for e-prescribing that ensures that Canadians’ prescription information can be more easily shared and accessed between relevant health providers, while respecting patient privacy and confidentiality. Strengthened National Immunization Strategy for Canada: Given Canada’s relatively low rates of immunization compared with other industrialized countries, CPhA is calling for a revamped National Immunization Strategy. The goal of a revamped strategy would be to increase immunization rates through a comprehensive approach that would include further expanding pharmacists’ scope of practice to administer vaccines. The National Strategy would also target increased research, comparable access and enhanced education/outreach, including building a partnership with the provinces/territories and health professionals to increase public awareness of the importance of vaccinations. In the lead-up to October 19, CPhA is encouraging pharmacists and other Canadians to promote and discuss these key recommendations with political candidates from all parties. To assist you, CPhA has assembled an election website at www.pharmacists.ca/election. On this website, you will find a print-ready brochure that summarizes the key recommendations, a more detailed platform document that provides background and rationale for these recommendations and an online tool that allows you to quickly and easily contact the candidates in your riding and send them messages of support for the above-mentioned priorities. Elections provide voters with an excellent opportunity to learn about and pin down the views of candidates and political parties on specific issues. This election is no different. Go to www.pharmacists.ca/election to share your thoughts with your candidates, and help CPhA advance these core issues. ■

Research Of Computerization And Implementation Of The E-Prescription For Individual Pharmacies

The paper deals with establishment, implementation and development of electronic prescription or e-Prescription in context with e-Health solutions. It includes introduction of a numerous innovative solutions, which are to be committed for data information flow, data management and functionality as well as of establishment of a new feasible communication forms between doctors, patients and pharmacists. The aim of the study is to describe some technical aspects and functionality of implementation of e-Prescription system for medical institutions, patients and pharmacies; and, calculation of the total cost of implementation (TCI) for Latvian individual pharmacies. Several expecting financial aspects, which have encompassed evaluation of TCI, calculating payback time, ROI, NPV, and IRR are to be calculated. On the bases of these financial calculations, the primary investment of implementation of e-Prescription for individual pharmacies and initial costs are determined. Impact on individual parts of TCI with the scope to individual pharmacy size, location, existence or absence of formal information strategy has calculated. According to collected data, research paper shows how proposed electronic system is going to implement among Latvian individual pharmacies.

Design and Evaluation of an Electronic Override Mechanism for Medication Alerts to Facilitate Communication Between Prescribers and Pharmacists.

Computerized medication alerts can often be bypassed by entering an override rationale, but prescribers' override reasons are frequently ambiguous to pharmacists who review orders. To develop and evaluate a new override mechanism for adverse reaction and drug-drug interaction alerts. We hypothesized that the new mechanism would improve usability for prescribers and increase the clinical appropriateness of override reasons. A counterbalanced, crossover study was conducted with 20 prescribers in a simulated prescribing environment. We modified the override mechanism timing, navigation, and text entry. Instead of free-text entry, the new mechanism presented prescribers with a predefined set of override reasons. We assessed usability (learnability, perceived efficiency, and usability errors) and used a priori criteria to evaluate the clinical appropriateness of override reasons entered. Prescribers rated the new mechanism as more efficient (Wilcoxon signed-rank test, P = 0.032). When first using the new design, 5 prescribers had difficulty finding the new mechanism, and 3 interpreted the navigation to mean that the alert could not be overridden. The number of appropriate override reasons significantly increased with the new mechanism compared with the original mechanism (median change of 3.0; interquartile range = 3.0; P < 0.0001). When prescribers were given a menu-based choice for override reasons, clinical appropriateness of these reasons significantly improved. Further enhancements are necessary, but this study is an important first step toward a more standardized menu of override choices. Findings may be used to improve communication through e-prescribing systems between prescribers and pharmacists.

A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks.

Evidence from the literature indicates that besides its benefits, e-prescribing also generates new types of unintended medication errors that have the potential to harm patient safety. Analyzing both the benefits and risks of e-prescribing can give health care organizations a better understanding of the improvements gained and errors generated by this technology. To review the primary functions of e-prescribing and its assimilation stages in the health care context. This review also aims to classify the potential benefits, risks and concerns associated with e-prescribing along with factors contributing to e-prescribing errors. A literature review was conducted primarily in Web of Sciences electronic databases. The online databases were searched for both peer-reviewed quantitative and qualitative research papers written in English and published between January 2008 and December 2014 (i.e., the last seven years). Several additional studies were also accessed through Google Scholar and the citations of the selected articles. A total of 73 publications met the study's inclusion criteria. The key benefits of e-prescribing were identified as improving the quality of health care services, increasing the efficiency and effectiveness of prescribing and dispensing medications, reducing medication errors, and health care cost savings. Failure to properly implement e-prescribing systems can also result in new types of errors that reduce workflow efficiency, increase medication cost, and threaten patient safety. In this study, factors contributing to potential errors were categorized into four primary groups (human, technical, interaction and organizational errors). This review identified the primary benefits and risks of e-prescribing services. The study contributes to the body of knowledge related to the design, adoption and use of e-prescribing by providing a clear reflection on its potential gains and risks. Based on the findings of this review, conducting research in several areas is quite promising as future work. This review also has practical implications for health care providers, e-prescribing software vendors and policy makers.

Evaluation of electronic prescription implications in Turkey: an investigation of the perceptions of physicians.

Electronic prescribing (e-prescribing) is an evolving area of healthcare information technology that aims to support physician decision-making by capturing, reviewing, and issuing medical prescriptions with high potential for improving the quality and safety of the process. To describe physician perception of e-prescription use in healthcare organizations that work with social security and to evaluate their infrastructures for MEDULA (an information system for billing and other health informatics) in healthcare organizations in Turkey. A cross-sectional survey design was used for this study. A convenience sample of physicians in eight general hospitals and in two oral and dental health centers of the Ministry of Health in Turkey were surveyed. Survey response rate was 47% (248/425). The majority of physicians (62%) support e-prescribing but have not used an electronic signature for prescriptions (78.2%). Almost half of them believe that e-prescriptions would positively contribute to patient safety (43%) Our study provides a first look at the perceptions of physicians regarding the implications of e-prescriptions, which became mandatory on January 15, 2013, in Turkey. Advocates of e-prescribing have suggested that additional efforts are needed to strengthen clinical decision systems. Physicians and nurses are better able to adopt e-prescribing systems and to view them positively if they recognize the limitations of paper-based prescribing and understand the utility of electronic systems in addressing some of these limitations. This study represents a starting point for government and related organizations to improve their knowledge on how well the implied benefits of e-prescriptions are realized in their acquisition, appraisal, and use in health policy decision-making and health systems.

Expert E-Prescription Application (EEPA) using Forward Chaining Method

Medical errors in reading doctor’s handwritten prescription are common in hospitals. These problems may harm the patient’s conditionif the pharmacist misreads a recipe given by the doctor. Therefore, Electronic prescribing (e-prescription) system is urgently needed to overcome faults in recipe prescription process. Pharmacist or medical staff can easily read a handwritten recipe by using an eprescription application. Here, we develop Expert E-Prescription Application (EEPA) utilized with recipe recommendation feature based on the disease symptoms. In this application, there are three types of user with the different access rights for each of them; doctor, pharmacist, and receptionist. EEPA facilitate the receptionist in registering, filling, and updating patient data. Doctor can generate a recommended recipe by typing the symptoms and also view the history of patient medical records. Pharmacist can also check patient’s prescription and give a medicine based on patient id number. Test result of this application which justified by the expert (doctor) give the accuracy of 91,67%.

Impact of Early Electronic Prescribing on Pharmacists' Clarification Calls in Four Community Pharmacies Located in St John's, Newfoundland.

BackgroundElectronic prescribing (e-prescribing) can potentially help prevent medication errors. As the use of e-prescribing increases across Canada, understanding the benefits and gaps of early e-prescribing can help inform deployment of future e-prescribing systems.ObjectiveThe purpose of this exploratory study was to determine the prevalence of, reasons for, and average time taken for pharmacist clarification calls to prescribers for electronic medical record (EMR)-generated and handwritten prescriptions.MethodsFour community pharmacies in St John’s, Newfoundland, Canada prospectively collected information on clarification calls to prescribers for new prescriptions over a period of 17 to 19 weeks. Four semistructured interviews were conducted following the data collection period to gain further insight.ResultsAn estimated 1.33% of handwritten prescriptions required clarification compared with 0.66% of EMR-generated prescriptions. Overall, 1.11% of prescriptions required clarification with the prescriber. While illegibility was eliminated with EMR-generated prescriptions, clarification was still required for missing information (24%) and appropriateness (51%). Key themes, including errors unique to EMR-generated prescriptions, emerged from the qualitative interviews.ConclusionsAdvanced e-prescribing functionality will enable secure transmission of prescriptions from prescribers to a patient’s pharmacy of choice through a provincial electronic Drug Information System (DIS)/Pharmacy Network, which will lessen the need for clarification calls, especially in the domains of missing information and appropriateness of the prescription. This exploratory study provides valuable insight into the benefits and gaps of early e-prescribing. Advanced e-prescribing systems will provide an opportunity for further realization of quality and safety benefits related to medication prescribing.

Patient perceptions of e-prescribing and its impact on their relationships with providers: A qualitative analysis

To describe patients' perceptions of electronic (e)-prescribing and its impact on patients' quality of care, interactions with prescribers and pharmacists, and engagement in health care overall, particularly in regard to medication use. Semistructured, one-on-one interviews with 12 patients. Patients were generally unfamiliar with the functions of integrated e-prescribing systems and did not perceive that use of such technology affected their relationships with providers. Those respondents having positive perceptions of, and experiences with e-prescribing mostly cited convenience and improvements in safety and quality, while patients with negative e-prescribing perceptions and experiences primarily expressed concern about loss of control in the medication-use process, misdirected prescriptions, and reduced communication with prescribers and pharmacists. Patients generally felt unaffected by the use of e-prescribing technology; however, there may be opportunities to better engage and educate patients, particularly at the point of prescribing.

Chinese medicine students’ views on electronic prescribing: A survey in Hong Kong

IntroductionElectronic prescribing (e-prescribing) can potentially improve the quality of patient care in traditional Chinese medicine (TCM) by facilitating clinical tasks. Published survey studies investigating e-prescribing use were mostly conducted in conventional medicine, but these findings cannot be entirely generalised to TCM practice. It is important, therefore, to investigate e-prescribing in the TCM context. PurposeTo investigate Chinese medicine students’ attitudes and perceptions of e-prescribing use in Hong Kong. MethodQuestionnaires were distributed to TCM students in three Hong Kong universities between January and May 2013. There were 259 participants in this study. Questionnaires were distributed and collected during lectures. The data was analysed using descriptive statistics. ResultsThe overall response rate was 89.3%. Only 21.2% of survey respondents had previously used an e-prescribing system. However, 86.5% of the respondents stated they want to use e-prescribing after they qualify as TCM practitioners. Patient care efficiency was rated as the most favourable outcome of e-prescription compared to handwritten prescriptions. The reliability of the e-prescribing system was rated as a major concern. ConclusionTCM students in Hong Kong were generally supportive of e-prescribing uptake. However, this study raised concerns and potential barriers to e-prescribing use. Factors that may facilitate e-prescribing uptake in TCM are also suggested. Further studies investigating TCM practitioners’ views will be required to identify further facilitators and barriers to the uptake of e-prescribing.

Using stakeholder perspectives to develop an ePrescribing toolkit for NHS Hospitals: a questionnaire study.

SummaryObjectiveTo evaluate how an online toolkit may support ePrescribing deployments in National Health Service hospitals, by assessing the type of knowledge-based resources currently sought by key stakeholders.DesignQuestionnaire-based survey of attendees at a national ePrescribing symposium.Setting2013 National ePrescribing Symposium in London, UK.ParticipantsEighty-four delegates were eligible for inclusion in the survey, of whom 70 completed and returned the questionnaire.Main outcome measuresEstimate of the usefulness and type of content to be included in an ePrescribing toolkit.ResultsInterest in a toolkit designed to support the implementation and use of ePrescribing systems was high (n = 64; 91.4%). As could be expected given the current dearth of such a resource, few respondents (n = 2; 2.9%) had access or used an ePrescribing toolkit at the time of the survey. Anticipated users for the toolkit included implementation (n = 62; 88.6%) and information technology (n = 61; 87.1%) teams, pharmacists (n = 61; 87.1%), doctors (n = 58; 82.9%) and nurses (n = 56; 80.0%). Summary guidance for every stage of the implementation (n = 48; 68.6%), planning and monitoring tools (n = 47; 67.1%) and case studies of hospitals’ experiences (n = 45; 64.3%) were considered the most useful types of content.ConclusionsThere is a clear need for reliable and up-to-date knowledge to support ePrescribing system deployments and longer term use. The findings highlight how a toolkit may become a useful instrument for the management of knowledge in the field, not least by allowing the exchange of ideas and shared learning.

Implementation of vancomycin dosing nomogram in an electronic prescribing system: an innovative tool in antibiotic stewardship

Vancomycin (VAN) is the gold standard therapy for Methicillin-resistant Staphylococcus aureus(MRSA) infections such as bacteremia and endocarditis. However, VAN suboptimal dosing for serious infections caused by S. aureus isolates that have elevated minimum inhibitory concentration (MIC), could be associated with poor outcome. Better understanding of VAN pharmacokinetics and pharmacodynamics (PK/PD) has led to the creation of new recommendations with optimized dosing regimens for the treatment of MRSA infections. For severe infectious, such as pneumonia and endocarditis, a VAN serum trough concentration of 15-20 mg/L at the steady state should be targeted. The aim of this study was to show how a nomogram with updated VAN dosing was devised and how it was implemented in the electronic prescribing (e-prescribing) system of a teaching hospital. VAN loading dose and maintenance doses were calculated from a pharmacokinetic equation using basic parameters: weight, estimated creatinine clearance, as well as peak and trough serum concentrations. The implementation of the VAN dosing nomogram in the hospital e-prescribing system definitively changed the long-standing medical prescription fallacy of "same dose fits all". Finally, this computer-based electronic program has allowed a wide-ranging intervention and should be recognized as a powerful tool for implementation in antimicrobial stewardship programs.

Getting Strategic Advantage by Measuring Resistance Developed against E-Prescription in Turkey

To get strategic advantage countrywide and improve the control over medicines, it was decided to develop an e-prescription system by gathering all users of prescription such as doctors, governments, and pharmacies in the same platform on 01 July 2012. One of the main aims of this initiative is to prevent frauds. When e-prescription was first started in Turkey, there was an aggressive resistance against it. It was decided to measure resistance developed over time by a survey and find ways to decrease that resistance. For that purpose, 370 users are survey in Istanbul, Kayseri and Erzurum cities in 2013. Moreover, some open questions are asked to learn real reasons behind resistance from end users and to develop some suggestions to improve the adoption of e-prescription. It was found that there was a big resistance at the beginning and this resistance has decreased over time. Kayseri city showed the lowest resistance in all months. Users have stated that there was not an extensive education on how to use it and that is why there was a huge resistance at the beginning. Outages have been seen one of the greatest reasons behind that resistance. Security and privacy of patients records have not been seen a problem in future by users.

The impacts of second generation e-prescribing usability on community pharmacists outcomes.

The results from past studies about the effects of second-generation e-prescribing systems on community pharmacists' outcomes and practices are inconclusive, and the claims of effectiveness and efficiency of such systems have not been supported in all studies. There is a strong need to study the factors that lead to positive outcomes for the users of these systems. This paper intends to bridge the above gaps by empirically examining the impacts of user interface usability on the community pharmacists' outcomes. A quantitative survey research method was used and the data was collected from the community pharmacists, who use an e-prescribing system. Data from 152 questionnaires collected in a national survey were used to for the study. Partial Least Squares (PLS) path modeling was used to examine scale reliability, validity and hypotheses. The scale was found to test well for reliability and validity. Examining the hypotheses illustrated that ease of use (P<0.01, t=5.79) and information quality (P<0.01, t=6.24) of an e-prescribing system improved pharmacists' outcomes (including communication, facilitation of care, reduction of workload and medical errors) while ease of use of the system was influenced by user interface consistency (P<0.01, t=7.35) and system error prevention (P<0.01, t=5.29). To improve community pharmacists' outcomes and practices, the ease of use, information quality, consistency and error prevention features of e-prescribing systems should be improved. It was found that information quality had a stronger impact on the outcomes and hence improving the quality of the generated information would have higher impacts on users' outcomes.

An evaluation of e-prescribing at a national level

Objective: The aim of the article is to describe the process of implementing the Estonian national second generation electronic prescription service (e-prescription) and determine if the objectives set by the Estonian government were fulfilled.Materials and methods: The study presents an analysis of both retrospective and current data in the evaluation phase of a design research project. Sources include, among others, publicly available documents and previous evaluation studies.Results: According to all of the major stakeholders, the Estonian e-prescription service has very high usability and user satisfaction scores have been high. There is only little empirical evidence available to confirm if the benefits aimed for in the creation of the service were achieved. From a public administration viewpoint, the implementation of e-prescription has led to potential efficiency gains.Conclusion: The Estonian second-generation e-prescription system is widely used by citizens, healthcare providers and administrators alike. However, there are gaps in measuring the impact of the service, especially with respect to time savings and enhanced healthcare quality. Additional functionalities will be key drivers in creating benefits for all stakeholders. Future nationwide e-health services should have a more rigorous evaluation process carried out during the design and implementation stages.

Healthcare information technology infrastructures in Turkey.

The objective of this paper is to describe some of the major healthcare information technology (IT) infrastructures in Turkey, namely, Sağlık-Net (Turkish for "Health-Net"), the Centralized Hospital Appointment System, the Basic Health Statistics Module, the Core Resources Management System, and the e-prescription system of the Social Security Institution. International collaboration projects that are integrated with Sağlık-Net are also briefly summarized. The authors provide a survey of the some of the major healthcare IT infrastructures in Turkey. Sağlık-Net has two main components: the National Health Information System (NHIS) and the Family Medicine Information System (FMIS). The NHIS is a nation-wide infrastructure for sharing patients' Electronic Health Records (EHRs). So far, EHRs of 78.9 million people have been created in the NHIS. Similarly, family medicine is operational in the whole country via FMIS. Centralized Hospital Appointment System enables the citizens to easily make appointments in healthcare providers. Basic Health Statistics Module is used for collecting information about the health status, risks and indicators across the country. Core Resources Management System speeds up the flow of information between the headquarters and Provincial Health Directorates. The e-prescription system is linked with Sağlık-Net and seamlessly integrated with the healthcare provider information systems. Finally, Turkey is involved in several international projects for experience sharing and disseminating national developments. With the introduction of the "Health Transformation Program" in 2003, a number of successful healthcare IT infrastructures have been developed in Turkey. Currently, work is going on to enhance and further improve their functionality.

Correction: Product Diversity and Spectrum of Choice in Hospital ePrescribing Systems in England

There are two errors in the author byline in the XML version of the article. The sixth author’s name is spelled incorrectly. The correct name is: Aziz Sheikh. Jamie Coleman should not be listed as an author. The correct author byline is: Hajar Mozaffar, Robin Williams, Kathrin Cresswell, Zoe Morison, Ann Slee, Aziz Sheikh on behalf of the ePrescribing Programme Team.

Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies.

BackgroundThis protocol concerns the assessment of cost-effectiveness of hospital health information technology (HIT) in four hospitals. Two of these hospitals are acquiring ePrescribing systems incorporating extensive decision support, while the other two will implement systems incorporating more basic clinical algorithms. Implementation of an ePrescribing system will have diffuse effects over myriad clinical processes, so the protocol has to deal with a large amount of information collected at various ‘levels’ across the system.Methods/DesignThe method we propose is use of Bayesian ideas as a philosophical guide.Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit – the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted. There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect). For each category we will elicit and pool subjective probability densities from experts for reductions in adverse events, resulting from deployment of the intervention in a hospital with extensive decision support. The experts will have been briefed with quantitative and qualitative data from the study and external data sources prior to elicitation. Following this, there will be a process of deliberative dialogues so that experts can “re-calibrate” their subjective probability estimates. The consolidated densities assembled from the repeat elicitation exercise will then be used to populate a health economic model, along with salient utilities. The credible limits from these densities can define thresholds for sensitivity analyses.DiscussionThe protocol we present here was designed for evaluation of ePrescribing systems. However, the methodology we propose could be used whenever research cannot provide a direct and unbiased measure of comparative effectiveness.