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Electronic Prescribing Improves Medication Safety in Community-Based Office Practices

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Abstract

BACKGROUND

Although electronic prescribing (e-prescribing) holds promise for preventing prescription errors in the ambulatory setting, research on its effectiveness is inconclusive.

OBJECTIVE

To assess the impact of a stand-alone e-prescribing system on the rates and types of ambulatory prescribing errors.

DESIGN, PARTICIPANTS

Prospective, non-randomized study using pre-post design of 15 providers who adopted e-prescribing with concurrent controls of 15 paper-based providers from September 2005 through June 2007.

INTERVENTION

Use of a commercial, stand-alone e-prescribing system with clinical decision support including dosing recommendations and checks for drug-allergy interactions, drug-drug interactions, and duplicate therapies.

MAIN MEASURES

Prescribing errors were identified by a standardized prescription and chart review.

KEY RESULTS

We analyzed 3684 paper-based prescriptions at baseline and 3848 paper-based and electronic prescriptions at one year of follow-up. For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions (95% confidence interval (CI), 36.7–49.3) at baseline to 6.6 per 100 prescriptions (95% CI, 5.1–8.3) one year after adoption (p < 0.001). For non-adopters, error rates remained high at 37.3 per 100 prescriptions (95% CI, 27.6–50.2) at baseline and 38.4 per 100 prescriptions (95% CI, 27.4–53.9) at one year (p = 0.54). At one year, the error rate for e-prescribing adopters was significantly lower than for non-adopters (p < 0.001). Illegibility errors were very high at baseline and were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year).

CONCLUSIONS

Prescribing errors may occur much more frequently in community-based practices than previously reported. Our preliminary findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety.

TRIAL REGISTRATION

ClinicalTrials.gov, Taconic Health Information Network and Community (THINC), NCT00225563, http://clinicaltrials.gov/ct2/show/NCT00225563?term=Kaushal&rank=6.

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Acknowledgements

The authors thank A. John Blair, III, MD, President of the Taconic IPA and CEO of MedAllies and Dianne Koval, MHSA, RHIA, CPEHR, Vice President of Provider Services for MedAllies for their assistance in enrolling office practices.

This project was supported by the Agency for Healthcare Research and Quality (1 UC1 HS016316), Rockville, MD.

Funding/Support

This project was supported by the Agency for Healthcare Research and Quality (1 UC1 HS01636), Rockville, MD.

Conflict of Interest Disclosure Statement

None of the authors have any financial interests that present a conflict of interest.

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Authors and Affiliations

  1. Department of Pediatrics, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY, 10065, USA

    Rainu Kaushal MD, MPH

  2. Department of Medicine, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY, 10065, USA

    Rainu Kaushal MD, MPH

  3. Department of Public Health, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY, 10065, USA

    Rainu Kaushal MD, MPH

  4. New York-Presbyterian Hospital, New York, NY, USA

    Rainu Kaushal MD, MPH, Lisa M. Kern MD, MPH & Erika L. Abramson MD

  5. Health Information Technology Evaluation Collaborative (HITEC), New York, NY, USA

    Rainu Kaushal MD, MPH, Lisa M. Kern MD, MPH, Yolanda Barrón MS & Erika L. Abramson MD

  6. Department of Public Health, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-255, New York, NY, 10065, USA

    Lisa M. Kern MD, MPH

  7. Department of Medicine, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-255, New York, NY, 10065, USA

    Lisa M. Kern MD, MPH

  8. Department of Public Health, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-236, New York, NY, 10065, USA

    Yolanda Barrón MS

  9. Taconic IPA, Fishkill, NY, USA

    Jill Quaresimo RN, JD

  10. Department of Pediatrics, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-261, New York, NY, 10065, USA

    Erika L. Abramson MD

Authors
  1. Rainu Kaushal MD, MPH
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  2. Lisa M. Kern MD, MPH
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  3. Yolanda Barrón MS
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  4. Jill Quaresimo RN, JD
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  5. Erika L. Abramson MD
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Corresponding author

Correspondence to Rainu Kaushal MD, MPH.

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Kaushal, R., Kern, L.M., Barrón, Y. et al. Electronic Prescribing Improves Medication Safety in Community-Based Office Practices. J GEN INTERN MED 25, 530–536 (2010). https://doi.org/10.1007/s11606-009-1238-8

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  • DOI: https://doi.org/10.1007/s11606-009-1238-8

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