Electronic Prescribing Improves Medication Safety in Community-Based Office Practices
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Although electronic prescribing (e-prescribing) holds promise for preventing prescription errors in the ambulatory setting, research on its effectiveness is inconclusive.
To assess the impact of a stand-alone e-prescribing system on the rates and types of ambulatory prescribing errors.
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.
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.
Prescribing errors were identified by a standardized prescription and chart review.
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).
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.
ClinicalTrials.gov, Taconic Health Information Network and Community (THINC), NCT00225563, http://clinicaltrials.gov/ct2/show/NCT00225563?term=Kaushal&rank=6.
KEY WORDSelectronic prescribing ambulatory medication safety
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.
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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