Purpose: The purpose of this study is to examine the adoption of e-prescribing by primary care physicians in the Cowichan Valley Community of Practice (COP) who use the same commercial EMR product (Med Access EMR) and to make suggestions on improving adoption. Methods: This study employed a multi-method study design to compare the ideal state of e-prescribing (i.e., the desired e-prescribing features in an EMR) with the possible state (i.e., what the EMR can offer) and the current state of e-prescribing (i.e., what physicians are actually using in practice).The ideal state of e-prescribing was determined using a literature search in MEDLINE, a personal collection, and reference mining.The possible state for e-prescribing was assessed by (1) reviewing the EMR user documentation and (2) reviewing provincial conformance specifications for EMRs (from Physician Information Technology Office (PITO)) and (3) interviewing an EMR vendor representative to confirm features. Based on this review, an e-prescribing assessment tool was then developed and piloted with physicians.The current state of e-prescribing was examined by interviewing physicians using the aforementioned e-prescribing assessment tool and an EMR Adoption Survey. A discussion group then took place to share the study findings and provide feedback on how to improve use of the EMR for prescribing. Results: For the ideal state of e-prescribing, 10 papers were included in the literature search as a part of the search strategy. In total, 104 e-prescribing features were identified in these papers relating to the following categories: patient Information, identification, and data access, current medications/medication history, medication selection, prescribing safety, patient education, monitoring, repeat (renewal) prescribing, computer-user interface, transparency and accountability, security and confidentiality, and interoperability and communication.For the possible state of e-prescribing, the EMR product met 27 of the 33 PITO e-prescribing requirements partially or fully, relating to the following PITO subcategories: generating prescriptions, processing prescriptions, transmitting prescriptions, viewing medications, managing renewals, drug formularies, interaction checking, medication profiles, and reference support. Data pertaining to the current state of e-prescribing adoption were collected from interviews with 12 primary care physicians who represent 17% of the total sample population. On average, the physicians reported using 75% (n=21.7/29) of the e-prescribing features available in the EMR. The e-prescribing features least used were “drug search by class”, “check for patient coverage”, “drug to procedure interaction checking”, and “use of drug monographs”. The average EMR Adoption score for physicians was 3.1 out of 5. A discussion group with six study participants was conducted to validate the findings of the current state and recommendations. Conclusions/ Recommendations: Recruited physicians from the Cowichan Valley COP are using most of the e-prescribing and EMR features available in the Med Access EMR. However, there are several gaps between the ideal, possible, and current state of e-prescribing. These gaps have been addressed through physician-level, policy-related, and technology-related recommendations to (1) help physicians improve use of the EMR for prescribing to achieve the possible state of e-prescribing and (2) guide vendor design and development of e-prescribing features in the EMR to achieve the ideal state of e-prescribing. / Graduate / 0723 / 0566 / 0984 / gurprit@uvic.ca