The use of discrete-event simulation modeling to compare handwritten and electronic prescribing systems

Electronic prescribing (e-prescribing) is expected to bring many benefits to Canadian healthcare, such as a reduction in errors and adverse drug reactions. As there currently is no functioning e-prescribing system in Canada that is completely electronic, we are unable to evaluate the performance of a live system. An alternative approach is to use simulation modeling for evaluation. We developed two discrete-event simulation models, one of the current handwritten prescribing system and one of a proposed e-prescribing system, to compare the performance of these two systems. We were able to compare the number of processes in each model, workflow efficiency, and the distribution of patients or prescriptions. Although we were able to compare these models to each other, using discrete-event simulation software was challenging. We were limited in the number of variables we could measure. We discovered non-linear processes and feedback loops in both models that could not be adequately represented using discrete-event simulation software. Finally, interactions between entities in both models could not be modeled using this type of software. We have come to the conclusion that a more appropriate approach to modeling both the handwritten and electronic prescribing systems would be to use a complex adaptive systems approach using agent-based modeling or systems-based modeling.