A long-term follow-up evaluation of electronic health record prescribing safety.

Abramson EL, Malhotra S, Osorio SN, Edwards A, Cheriff A, Cole C, Kaushal R.

Source

Department of Pediatrics, Weill Cornell Medical College, New York, New York 10065, USA. err9009@med.cornell.edu

Abstract

OBJECTIVE:

To be eligible for incentives through the Electronic Health Record (EHR) Incentive Program, many providers using older or locally developed EHRs will be transitioning to new, commercial EHRs. We previously evaluated prescribing errors made by providers in the first year following transition from a locally developed EHR with minimal prescribing clinical decision support (CDS) to a commercial EHR with robust CDS. Following system refinements, we conducted this study to assess the rates and types of errors 2 years after transition and determine the evolution of errors.

MATERIALS AND METHODS:

We conducted a mixed methods cross-sectional case study of 16 physicians at an academic-affiliated ambulatory clinic from April to June 2010. We utilized standardized prescription and chart review to identify errors. Fourteen providers also participated in interviews.

RESULTS:

We analyzed 1905 prescriptions. The overall prescribing error rate was 3.8 per 100 prescriptions (95% CI 2.8 to 5.1). Error rates were significantly lower 2 years after transition (p<0 .001="" 12="" 1="" after="" alert="" and="" appreciated="" compared="" firing.="" misses="" most="" near="" of="" p="" particularly="" positively="" pre-implementation="" providers="" rates="" reduced="" refinements="" remained="" system="" to="" transition="" unchanged.="" weeks="" year="">

DISCUSSION:

Our study suggests that over time and with system refinements, use of a commercial EHR with advanced CDS can lead to low prescribing error rates, although more serious errors may require targeted interventions to eliminate them. Reducing alert firing frequency appears particularly important. Our results provide support for federal efforts promoting meaningful use of EHRs.