The transition to new electronic prescribing systems can create patient-safety dangers, according to researchers at Weill Cornell Medical College, who recommend more individual training for providers and for electronic health-record system vendors to design clinical decision-support tools better tailored to catch mistakes.
Researchers find e-prescribing safety risks
The researchers studied electronic prescribing among 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009. They analyzed 1,298 prescriptions on the clinic's old EHR system, 1,331 prescriptions 12 weeks after the clinic implemented a new system (described as being certified by the Certification Committee for Health Information Technology as having "more robust clinical decision support"), and the status of e-prescribing one year after the new system's implementation. The study (PDF), published online in the Journal of General Internal Medicine, was funded by the Agency for Healthcare Research and Quality.
Prescriptions were analyzed for errors, including inappropriate use of abbreviations, and errors in directions, frequency, dose and amount to be dispensed. Errors were highest at baseline—35.7 per 100 prescriptions—and lowest one year after the new system's implementation, 12.2 per 100. Researchers noted, however, that the improvement resulted primarily from reducing the rates for inappropriate abbreviations. The rate for other errors was highest 12 weeks after implementation (17.7 errors per 100 prescriptions), and the baseline and one-year post-implementation rate were almost the same: 8.5 and 10.8, respectively.
In all, 557 errors were reported under the old system, 338 errors were reported after 12 weeks; and 191 were reported one year after implementation.
"Although the majority of the prescribing errors we detected lacked potential to cause serious harm, these errors can result in inefficiencies (such as pharmacy callbacks) and thus are important to study," the report concluded. "Research has shown that pharmacy callbacks are common and often lead to delays in medication dispensing that pose threats to patient safety."
Fifteen of the 17 physicians were also surveyed on their views about the systems, and 40% said they weren't satisfied with the new system. Furthermore, only one-third said they thought it was safer than the old one. "Alert fatigue was also widespread," according to the report, with 60% of responding physicians saying the alerts weren't useful, and two-thirds stating that the new system slowed down drug orders and refills.
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