Electronic prescribing improves medication safety in community-based office practices

Electronic prescribing improves medication safety in community-based office practices.
Kaushal R, Kern LM, Barrón Y, Quaresimo J, Abramson EL. J Gen Intern Med. 2010 Feb 26; [Epub ahead of print].

Few ambulatory practices use electronic health records (EHRs) in any form, and even those that do generally do not utilize advanced functions such as computerized provider order entry (CPOE). Cost and a lack of high-quality efficacy data are frequently cited as barriers to EHR and CPOE adoption. This controlled trial compared prescribing error rates in 15 ambulatory practices that adopted a commercial e-prescribing system to those of 15 practices that continued using standard paper prescriptions, and found a striking reduction in prescribing errors in the CPOE group. Such safety data may help make the business case for adopting CPOE in the ambulatory setting. A Patient Safety Primer discusses medication errors and other common safety problems in ambulatory care.

Rainu Kaushal1, 2, 3, 4, 5 , Lisa M. Kern4, 5, 6, 7, Yolanda Barrón5, 8, Jill Quaresimo9 and Erika L. Abramson4, 5, 10

(1) Department of Pediatrics, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY 10065, USA
(2) Department of Medicine, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY 10065, USA
(3) Department of Public Health, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY 10065, USA
(4) New York-Presbyterian Hospital, New York, NY, USA
(5) Health Information Technology Evaluation Collaborative (HITEC), New York, NY, USA
(6) Department of Public Health, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-255, New York, NY 10065, USA
(7) Department of Medicine, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-255, New York, NY 10065, USA
(8) Department of Public Health, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-236, New York, NY 10065, USA
(9) Taconic IPA, Fishkill, NY, USA
(10) Department of Pediatrics, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-261, New York, NY 10065, USA

Received: 10 July 2009 Revised: 10 December 2009 Accepted: 18 December 2009 Published online: 26 February 2010

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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