Journal of General Internal Medicine

, Volume 26, Issue 8, pp 868–874 | Cite as

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

  • Erika L. AbramsonEmail author
  • Sameer Malhotra
  • Karen Fischer
  • Alison Edwards
  • Elizabeth R. Pfoh
  • S. Nena Osorio
  • Adam Cheriff
  • Rainu Kaushal
Original Research



Healthcare providers previously using older electronic health records (EHRs) with electronic prescribing (e-prescribing) are transitioning to newer systems to be eligible for federal meaningful use incentives. Little is known about the safety effects of transitioning between systems.


To assess the effect of transitioning between EHR systems on rates and types of prescribing errors, as well as provider perceptions about the effect on prescribing safety.


Prospective, case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009. All physicians transitioned from an older EHR with minimal clinical decision support (CDS) for e-prescribing to a newer EHR with more robust CDS.


Prescribing errors were identified by standardized prescription and chart review. A novel survey instrument was administered to evaluate provider perceptions about prescribing safety.


We analyzed 1298 prescriptions at baseline, 1331 prescriptions 12 weeks post-implementation, and 1303 prescriptions one year post-implementation. Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions, 95% confidence interval (CI) 23.2–54.8) and lowest one year post-implementation (12.2 per 100 prescriptions, 95% CI 8.6–17.4) (p < 0.001). Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors. However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions, 95% CI 9.5–33.0 versus 8.5 per 100 prescriptions, 95% CI 4.6-15.9) (p <0.001) and no different at baseline than one year (10.2 per 100 prescriptions, 95% CI 6.2–18.6) (p = 0.337). Survey results complemented quantitative findings.


Results from this case study suggest that transitioning between systems, even to those with more robust CDS, may pose important safety threats. Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits.


electronic prescribing ambulatory transition 



The authors thank Dr. Fran Ganz-Lord for her assistance enrolling physicians, and Drs. James Hollenberg and Curtis Cole for assistance in retrieving electronic data. This project was supported by the Agency for Healthcare Research and Quality (R18HS017029), Rockville, MD.


This project was supported by the Agency for Healthcare Research and Quality (R18HS017029), Rockville, MD.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Erika L. Abramson
    • 1
    • 2
    • 3
    • 4
    Email author
  • Sameer Malhotra
    • 2
    • 4
  • Karen Fischer
    • 3
  • Alison Edwards
    • 2
    • 4
  • Elizabeth R. Pfoh
    • 2
    • 4
  • S. Nena Osorio
    • 1
    • 3
    • 4
  • Adam Cheriff
    • 3
    • 5
  • Rainu Kaushal
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.Department of PediatricsWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of Public HealthWeill Cornell Medical CollegeNew YorkUSA
  3. 3.New York-Presbyterian HospitalNew YorkUSA
  4. 4.Health Information Technology Evaluation Collaborative (HITEC)New YorkUSA
  5. 5.Department of MedicineWeill Cornell Medical CollegeNew YorkUSA

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