Analysis of medication therapy discontinuation orders in new electronic prescriptions and opportunities for implementing CancelRx

Yang, Yuze; Ward-Charlerie, Stacy; Kashyap, Nitu; deMayo, Richelle; Agresta, Thomas; Green, James

doi:10.1093/jamia/ocy100

Cited by 12 publications

(11 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 At times, prescribers attempt to prevent subsequent pharmacy dispenses by modifying the medication order in the EHR and sending a new prescription with "stop" or "cancel" in a free-text field, again hoping that the pharmacists will see and understand the message. 4…”

Section: Invited Commentarymentioning

confidence: 99%

Underuse of Electronic Health Record Features—The Case for CancelRx

Nelson

Kumah-Crystal

2021

JAMA Intern Med

View full text Add to dashboard Cite

show abstract

Section: Invited Commentarymentioning

confidence: 99%

Underuse of Electronic Health Record Features—The Case for CancelRx

Nelson

Kumah-Crystal

2021

JAMA Intern Med

View full text Add to dashboard Cite

show abstract

“…15 However, most EHRs do not currently notify pharmacies when prescribers discontinue or change medications; instead, prescribers are expected to call or fax pharmacies to communicate this information. An analysis of a sample of new e-prescriptions identified messages to discontinue another prescription in 0.7% of transactions, or an estimated 10 million e-prescriptions annually, 16 which likely represents a small fraction of medication discontinuations.…”

Section: Background and Significancementioning

confidence: 99%

Understanding CancelRx: Results of End-to-End Functional Testing, Proactive Risk Assessment, and Pilot Implementation

et al. 2019

View full text Add to dashboard Cite

Background CancelRx allows prescribers to send electronic cancellation messages to pharmacies when medications are discontinued. Little is known about its functionality and impact on clinical workflows. Objectives To understand CancelRx functionality, its potential impact on workflows and medication safety risks, and to develop mitigating strategies for risks introduced by implementation. Methods We conducted direct observations and semi-structured interviews to develop CancelRx use cases and assessed CancelRx in an end-to-end test environment, proactive risk assessment, and pilot implementation from April 16 to July 15, 2018. Results E-cancellations were sent upon discontinuation of e-prescriptions written within the electronic health record (EHR), but not other medications (e.g., printed prescriptions) and could be initiated by nonprescribers. In our proactive risk assessment, CancelRx implementation eliminated five of seven failure modes in outpatient prescribing to Johns Hopkins pharmacies, but introduced new risks, including (1) failure to act if an e-cancellation was not sent or was unsuccessful; (2) failure to cancel all prescriptions for a medication; (3) errors in manual matching; and (4) erroneous medication cancellations. We identified potential mitigation strategies for these risks. During pilot implementation, 92.4% (428/463) of e-cancellations had confirmed approval by the receiving pharmacy, while 4.5% (21/463) were denied, and 3.0% (14/463) had no e-cancellation response. Among e-cancellations received by the pilot pharmacy, 1.7% (7/408) required manual matching by pharmacy staff. Based on performance in testing, 73.4% (340/463) of completed e-cancellations would be expected to generate an in-basket message, including 21 (6.2%) denials and 319/340 (93.8%) approvals with a note from the pharmacy. Conclusion CancelRx is an important functionality with the potential to decrease adverse events due to medication errors. However, changes in implementation in our EHR and pharmacy software and enhancements in the CancelRx standard are needed to maximize safety and usability. Further studies are needed to evaluate the impact of e-cancellation on medication safety.

show abstract

“…Discovering these risks is more likely to eliminate them if found by the pharmacist or by including more features in the system. These features will support the prescriber's decision to the benefit of patients' safety (Odukoya et al, 2014 ; Reed-Kane et al, 2014 ; Salmon and Jiang, 2012 ; Yang et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Digital Health in Physicians' and Pharmacists' Office: A Comparative Study of e-Prescription Systems' Architecture and Digital Security in Eight Countries

Aldughayfiq

Sampalli

2021

OMICS: A Journal of Integrative Biology

View full text Add to dashboard Cite

e-Prescription systems are key components and drivers of digital health. They can enhance the safety of the patients, and are gaining popularity in health care systems around the world. Yet, there is little knowledge on comparative international analysis of e-Prescription systems' architecture and digital security. We report, in this study, original findings from a comparative analysis of the e-Prescription systems in eight different countries,

show abstract

Analysis of medication therapy discontinuation orders in new electronic prescriptions and opportunities for implementing CancelRx

Abstract: Encouraging the use of CancelRx and reducing the misuse of NewRx fields would reduce workflow disruptions and unnecessary risks to patient safety.

Cited by 12 publications

References 17 publications

Underuse of Electronic Health Record Features—The Case for CancelRx

Underuse of Electronic Health Record Features—The Case for CancelRx

Understanding CancelRx: Results of End-to-End Functional Testing, Proactive Risk Assessment, and Pilot Implementation

Digital Health in Physicians' and Pharmacists' Office: A Comparative Study of e-Prescription Systems' Architecture and Digital Security in Eight Countries

Contact Info

Product

Resources

About