Get access

Barriers to Electronic Prescribing: Nebraska Pharmacists’ Perspective


  • Funding: Funding for this research was provided by the state of Nebraska. Marsha Morien is the co-chair of the eHealth Council of Nebraska. The authors acknowledge Anne Byers, eHealth and Community Information Technology Manager, Nebraska Information Technology Commission.

  • For further information, contact: Donald G. Klepser, PhD, MBA, Assistant Professor, Department of Pharmacy Practice, University of Nebraska Medical Center, 986045 Nebraska Medical Center, Omaha, NE 68198-6045; e-mail:


Purpose: Electronic prescribing (e-prescribing) and its accompanying clinical decision support capabilities have been promoted as means for reducing medication errors and improving efficiency. The objectives of this study were to identify the barriers to adoption of e-prescribing among nonparticipating Nebraska pharmacies and to describe how the lack of pharmacy participation impacts the ability of physicians to meet meaningful use criteria.

Methods: We interviewed pharmacists and/or managers from nonparticipating pharmacies to determine barriers to the adoption of e-prescribing. We used open-ended questions and a structured questionnaire to capture participants’ responses.

Findings: Of the 23 participants, 10 (43%) reported plans to implement e-prescribing sometime in the future but delayed participation due to transaction fees and maintenance costs, as well as lack of demand from customers and prescribers to implement e-prescribing. Nine participants (39%) reported no intention to e-prescribe in the future, citing start-up costs for implementing e-prescribing, transaction fees and maintenance costs, happiness with the current system, and lack of understanding about e-prescribing's benefits and how to implement e-prescribing.

Conclusions: The barriers to e-prescribing identified by both late adopters and those not willing to accept e-prescriptions were similar and were mainly initial costs and transaction fees associated with each new prescription. For some rural pharmacies, not participating in e-prescribing may be a rational business decision. To increase participation, waiving or reimbursing transaction fees, based on demographic or financial characteristics of the pharmacy, may be warranted.