E-prescribing is touted as the entrée to more robust healthcare information system adoption in outpatient medical offices. Yet adoption has been slow with less than two percent of 2007 prescriptions done electronically in the United States. The discovery of widespread use of surrogate prescribers and evidence of unintended artifact usage suggests that the intended design has overlooked existing manual prescribing practices (e.g., roles and routines).  If these changes can be traced to documented existing practices reported in the literature, these insights may allow designers to anticipate the impact of their designs as new technologies are introduced.  Changes induced by e-prescribing systems are identified using a roles-artifact-routine analytical framework applied to the prescribing activities in physician offices and pharmacies.  The model of the prescribing process, both manual and electronic, is synthesized from the broader medication management literature that extends beyond those studies focused on e-prescribing alone.  Several artifact-induced changes to roles and routines surfaced by this framework suggest that the adoption challenges of e-prescribing technology go beyond those previously identified (e.g., financial barriers).