Difference between revisions of "Effect of EHR user interface changes on internal prescription discrepancies"

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==Introduction==
 
==Introduction==
According to the authors, “...changes in clinical workflow resulting from introduction of EHRs can have unforeseen consequences. Investigators have noted mistakes in data entry resulting from juxtaposition errors, entry of orders into the wrong patient’s record, mismatches between the real-life clinical workflow and the one “envisaged” by the EHR, increased workload for clinicians”. An internal prescription discrepancy arises when two components of a single prescription contradict each other: e.g. “1 capsule po tid” vs. “take 2 tablets three times a day”. Most commonly these discrepancies arise between the structured (dropdowns that allow user to populate prescription with values from standard vocabularies) and free-text components of electronic prescriptions.” <ref name="Turchin (2014)"> Turchin, A., Sawarkar, A., Dementieva, Y.A., Breydo, E., Ramelson, H. (2014). Effect of EHR user interface changes on internal prescription discrepancies. Applied Clinical Informatics 2014; 5: 708-720, http://dx.doi.org/10.4338/ACI-2014-03-RA-0023. http://www.ncbi.nlm.nih.gov/pubmed/25298811 (Accessed on 7 Nov 2015)</ref>
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According to the authors, “...changes in clinical workflow resulting from introduction of EHRs can have unforeseen consequences. Investigators have noted mistakes in data entry resulting from juxtaposition errors, entry of orders into the wrong patient’s record, mismatches between the real-life clinical workflow and the one “envisaged” by the EHR, increased workload for clinicians”. <ref name="Turchin (2014)"> Turchin, A., Sawarkar, A., Dementieva, Y.A., Breydo, E., Ramelson, H. (2014). Effect of EHR user interface changes on internal prescription discrepancies. Applied Clinical Informatics 2014; 5: 708-720, http://dx.doi.org/10.4338/ACI-2014-03-RA-0023. http://www.ncbi.nlm.nih.gov/pubmed/25298811 (Accessed on 7 Nov 2015)</ref> "An internal prescription discrepancy arises when two components of a single prescription contradict each other: e.g. “1 capsule po tid” vs. “take 2 tablets three times a day”. Most commonly these discrepancies arise between the structured (dropdowns that allow user to populate prescription with values from standard vocabularies) and free-text components of electronic prescriptions.” <ref name="Turchin (2014)"> Turchin, A., Sawarkar, A., Dementieva, Y.A., Breydo, E., Ramelson, H. (2014). Effect of EHR user interface changes on internal prescription discrepancies. Applied Clinical Informatics 2014; 5: 708-720, http://dx.doi.org/10.4338/ACI-2014-03-RA-0023. http://www.ncbi.nlm.nih.gov/pubmed/25298811 (Accessed on 7 Nov 2015)</ref>
  
 
==Methods==
 
==Methods==

Revision as of 00:14, 19 November 2015

This is a review of a paper submitted by A. Turchin, A. Sawarkar, Y. A. Dementieva, E. Breydo, and H. Ramelson [1]


Research question:

Does changing the user interface (UI) of an electronic health record (EHR) medication module increase or decrease the incidence of internal prescription discrepancies?

Abstract

This study evaluated an electron health record medication module to determine whether changes in the user interface created an increase or decrease of internal prescription discrepancies. “A multivariable autoregressive integrated moving average (ARIMA) model was used to evaluate the effect of five UI changes in the EHR medication module on incidence of internal prescription discrepancies. “ [1] Over a study period from March 2006 through March 2009,175,725 (18.4%) prescriptions were found to have internal discrepancies. “The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%).” [1] The study determined that “several UI changes in the electronic medication module were effective in reducing the incidence of internal prescription discrepancies.” [1]

Introduction

According to the authors, “...changes in clinical workflow resulting from introduction of EHRs can have unforeseen consequences. Investigators have noted mistakes in data entry resulting from juxtaposition errors, entry of orders into the wrong patient’s record, mismatches between the real-life clinical workflow and the one “envisaged” by the EHR, increased workload for clinicians”. [1] "An internal prescription discrepancy arises when two components of a single prescription contradict each other: e.g. “1 capsule po tid” vs. “take 2 tablets three times a day”. Most commonly these discrepancies arise between the structured (dropdowns that allow user to populate prescription with values from standard vocabularies) and free-text components of electronic prescriptions.” [1]

Methods

The authors designed and validated a natural language processing tool to identify discrepancies between structured and narrative components of electronic medication prescriptions. They subsequently used this tool to conduct a retrospective analysis of the effects of a series of changes in the UI of the EHR medication module on the rate of internal prescription discrepancies over time. [1]

Results

Over an 8 year study period, “175,725 (18.4%) prescriptions were found to have internal discrepancies. The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%).” [1]

Conclusion

This large study found that adding an “as directed” option to the structured component of the EHR prescription module and reminding users to ensure that the structured and narrative components do not contradict each other decreased the incidence of internal electronic prescription discrepancies. “Further research is needed to identify interventions that could completely eliminate prescription discrepancies and their effect on patient outcomes.” [1]

Comments

Software design changes are needed because the software developer does not design everything to 100% of the user’s requirements. Sometimes the user does not fully understand their requirements until a user interface is designed and tested in a real time environment. This study was conducted for an 8 year period to determine if a pull down menu variable conflicted with a text input special instruction. What happened to the patients who were victims of the 175,725 (18.4%) prescriptions that were found to have internal discrepancies? Are two senior pharmacy students, used during this study period, able to validate a set of 1,000 randomly selected electronic prescriptions and manually review them for internal discrepancies? This appears to be a train wreck waiting to happen. It also appears that the changes to the user interfaces did not solve the problem. It just reduced the liability of the effects of possible risks that could result.

Reference

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Turchin, A., Sawarkar, A., Dementieva, Y.A., Breydo, E., Ramelson, H. (2014). Effect of EHR user interface changes on internal prescription discrepancies. Applied Clinical Informatics 2014; 5: 708-720, http://dx.doi.org/10.4338/ACI-2014-03-RA-0023. http://www.ncbi.nlm.nih.gov/pubmed/25298811 (Accessed on 7 Nov 2015)