E-prescribing systems within electronic health records reduce ambulatory prescribing errors in community-based practices
Physicians in community-based office practices have error rates nearly 50 percent lower 1 year after adopting a commercially available electronic prescribing (e-prescribing) system integrated within an electronic health record (EHR), according to a new study. The researchers found that physicians who switched from paper prescribing to e-prescribing ("adopters") reduced their error rates nearly 1.5-fold, from 26.0 to 16.0 per 100 prescriptions by the end of 1 year. For physicians in practices who continued to use paper prescriptions ("non-adopters"), errors remained high at 1 year (37.3 per 100 prescriptions). Illegibility errors were numerous at baseline and completely eliminated by e-prescribing. E-prescribing reduced many types of prescribing errors, including route errors, strength errors, use of inappropriate abbreviations, and refill errors.
Although most of the errors would not cause serious harm to patients, they could result in callbacks from pharmacies and inefficiencies for doctors, patients, and pharmacists. The researchers studied at total of 21 providers at baseline and 1 year. All providers worked in adult primary care practices located in a predominantly rural and suburban region of upstate New York. Providers all used paper prescriptions at the beginning of the study. Six providers adopted e-prescribing while another 15 providers continued to use paper prescribing during the study. Researchers analyzed 2,432 prescriptions at baseline and 2,079 prescriptions at one year. The e-prescribing system was a popular, commercially available system with clinical decision support integrated within an EHR. The system provided alerts for drug allergies, drug-drug and drug-disease interactions, duplicate therapies, and contraindications for pregnant and breastfeeding women.
Given that the Federal government and many State governments, led by New York State, are making unprecedented investments in health information technology such as EHRs and e-prescribing, understanding the effect of these systems in actual use is essential to ensure that funding targets effective interventions. Designing systems that are well suited to provider workflow and providing technical support is also important to maximize safety benefits. The study was funded in part by the Agency for Healthcare Research and Quality (HS15316).
More details are in "Electronic prescribing within an electronic health record reduces ambulatory prescribing errors," by Erika L. Abramson, M.D., M.S., Yolanda Barron, M.S., Jill Quaresimo, R.N., J.D., and others in the October 2011 The Joint Commission Journal on Quality and Patient Safety 37(10), pp. 470-478.
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