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Healthcare // Clinical Information Systems

E-Prescribing Doesn't Make The Grade

Outpatient electronic prescribing doesn't cut out the common mistakes made in manual systems, study finds.

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If you think electronic prescribing will solve the mistakes that occur when doctors hand-write prescriptions, think again. Findings from a study that assessed 3,850 computer-generated prescriptions show that 452, or 11.7%, contained a total of 466 errors. Of these, 163 (35%) were deemed to be potentially harmful. The researchers said these rates were not significantly better than those reported for handwritten prescribing systems.

A further breakdown of the numbers reveals that 58% of the 163 potentially harmful errors were classified as significant, and the remaining 42% were categorized as serious. None was life-threatening, the report said.

The report further explained that mistakes classified as "significant" posed little serious threat to life, such as rash, headache, or diarrhea; serious errors were not life threatening, and included low blood sugar, reduced heart rate, and fainting.

Results of the study, "Errors Associated With Outpatient Computerized Prescribing Systems," were published June 29 on the Journal of the American Medical Informatics Association (JAMIA) website.

"Providers appear to be rapidly adopting electronic health records and computerized prescribing, and one of the major anticipated benefits is expected to be through medication-error reduction," lead study author Dr. Karen Nanji of Massachusetts General Hospital, wrote with colleagues. "Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful use of the system does not decrease medication errors."

Other key findings of the study were:

-- Four out of 10 medication errors involved anti-inflammatory drugs and antibiotics (anti-infectives), and the most common types of drugs associated with errors were nervous system drugs (27%), cardiovascular drugs (13.5%), and anti-inflammatory/antibiotic medications (12.3%).

-- The prevalence of prescribing errors varied considerably, depending on the system used, ranging from 5% to 37% among the 13 systems analyzed. The frequency of certain types of errors was also associated with particular systems.

-- Around 60% of errors related to missing information, which the authors suggest should be relatively easy to eliminate by some judicious tweaking or providing better training for the users.

-- There is room for improvement. The authors suggest that enhanced features that could improve e-prescribing functionality might include "forcing functions" which would not allow a prescription to be completed if certain information was missing; decision support systems, such as maximum dose checks; and calculators, they say.

A May report from Surescript Systems indicated that the adoption of e-prescriptions was on the rise and noted that over 326 million prescriptions were routed electronically in 2010 versus 190 million in 2009--a 72% increase. According to the report, upcoming meaningful use requirements will further accelerate e-prescribing utilization through 2015.

The Healthcare IT Leadership Forum is a day-long venue where senior IT leaders in healthcare come together to discuss how they're using technology to improve clinical care. It happens in New York City on July 12. Find out more.

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