A long-term follow-up evaluation of electronic health record prescribing safety
This is a review of Abramson, E. L., Malhotra, S., Osorio, S. N., Edwards , A., Cheriff, A., Cole, & C., Kaushal, R. 2013 article, “A long-term follow-up evaluation of electronic health record prescribing safety”.
The authors of this article review the prescription error rate between two different Electronic Health Record (EHR) systems with an integrated Clinical Decision Support (CDS). For a facility to be eligible for EHR program incentives (such as Meaningful use), , facilities will need upgrade to commercial EHRs. The authors previously conducted a study examining two EHR systems. One locally developed EHR with minimal prescribing CDS, and the second a commercial with an improved CDS. They re-conducted the study 2 years after the transition to evaluate the errors.
A mixed methods cross-sectional case study was conducted at an ambulatory clinic from April to June 2010 and consisted of 16 physicians. The authors of this study reviewed prescriptions that were written by providers over a 2-week period with the commercial EHR. Interviews were also conducted to gain perspectives of the new changes regarding prescription safety and system usage.
Results and Discussion
After the 2 years of transition the authors reviewed 1,905 prescriptions and 6,131 prescriptions overall including the first study. The results indicated that error rates were found to be lower after implementation. “The overall prescribing error rate was 3.8 per 100 prescriptions”. The authors also found that with the new system improvements safety benefits improved significantly. One system improvement that was initiated was a feature in which limited alert firing. Physicians who were interviewed provided positive feedback towards the new feature as it help reduce alert fatigue.
This study provides evidence that having an EHR system with and integrated advanced CDS would be beneficial to any facility. The CDS reduces prescription error rates as well as provides system alerts to physicians and staff. The study also covered the alert fatigue dilemma that faces many healthcare facilities utilizing a CDS system. However, with customization and improved refinements alert fatigues will be a thing of the past. This article provides us with improved knowledge of what works and what doesn’t. As the study was also a follow-up study with reviewing improvements in the total error rate for the new system.
- Abramson, E. L., Malhotra, S., Osorio, S. N., Edwards , A., Cheriff, A., Cole, & C., Kaushal, R. (2013). A long-term follow-up evaluation of electronic health record prescribing safety. J Am Med Inform Assoc., 20(e1), e52-e58. doi: 10.1136/amiajnl-2012-001328 Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/?term=A+long-term+follow-up+evaluation+of+electronic+health+record+prescribing+safety