Journal of General Internal Medicine

, Volume 25, Issue 6, pp 530–536

Electronic Prescribing Improves Medication Safety in Community-Based Office Practices

  • Rainu Kaushal
  • Lisa M. Kern
  • Yolanda Barrón
  • Jill Quaresimo
  • Erika L. Abramson
Original Article

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.

KEY WORDS

electronic prescribing ambulatory medication safety 

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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Rainu Kaushal
    • 1
    • 2
    • 3
    • 4
    • 5
  • Lisa M. Kern
    • 4
    • 5
    • 6
    • 7
  • Yolanda Barrón
    • 5
    • 8
  • Jill Quaresimo
    • 9
  • Erika L. Abramson
    • 4
    • 5
    • 10
  1. 1.Department of PediatricsWeill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of MedicineWeill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of Public HealthWeill Medical College of Cornell UniversityNew YorkUSA
  4. 4.New York-Presbyterian HospitalNew YorkUSA
  5. 5.Health Information Technology Evaluation Collaborative (HITEC)New YorkUSA
  6. 6.Department of Public HealthWeill Medical College of Cornell UniversityNew YorkUSA
  7. 7.Department of MedicineWeill Medical College of Cornell UniversityNew YorkUSA
  8. 8.Department of Public HealthWeill Medical College of Cornell UniversityNew YorkUSA
  9. 9.Taconic IPAFishkillUSA
  10. 10.Department of PediatricsWeill Medical College of Cornell UniversityNew YorkUSA

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