Assessing the value of electronic prescribing in ambulatory care: A focus group study

Weingart, Saul N.; Massagli, Michael P.; Cyrulik, Adrienne; Isaac, Thomas; Morway, Laurinda; Sands, Daniel Z.; Weissman, Joel S.

doi:10.1016/j.ijmedinf.2009.03.007

Cited by 56 publications

(55 citation statements)

References 22 publications

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“…One study reports both positive and negative effects on various aspects of time and workload 37 . The results of qualitative studies in oncology and non-oncology settings [38][39][40] resemble the empirical evidence. The totality of the evidence reveals that, as with any new technology, cpoe will have both positive and negative effects on practice.…”

Section: Discussionmentioning

confidence: 73%

Computerized Prescriber Order Entry in the Outpatient Oncology Setting: From Evidence to Meaningful Use

et al. 2014

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ConclusionsDespite the paucity of oncology-specific research, cpoe should be used in outpatient chemotherapy delivery to reduce chemotherapy-related medication errors. Adoption by clinicians will be enhanced by cpoe processes that complement current practice and workflow processes. KEY WORDSComputerized prescriber order entry, outpatients, systematic review BACKGROUNDChemotherapy is an important type of treatment in the fight against many cancers. The very nature of chemotherapy's toxicity profile also creates potential for harm-and possibly death-if chemotherapy is not ordered, prepared, dispensed, and administered cautiously by members of the health care team.Medication errors can occur anywhere during the medication process from ordering to administration, and errors can compromise patient safety 1,2 . A Canadian study 3 estimated that 7.5% of patients admitted to acute care hospitals in Canada in 2000 experienced at least 1 adverse event. Drug-related adverse events were the second most common type of event, accounting for approximately 24% of all adverse events.Medication errors in oncology can be particularly serious, given the narrow therapeutic window and the high toxicities of antineoplastic drugs 4,5 . In a study conducted by Leape et al. 6 of adverse drug events, 39% of errors occurred in the physician order phase, with drug dosing accounting for 28% of all errors. Specific to chemotherapy, Gandhi et al. 7 revealed that the most common source of error was within the order phase and that, compared with non-chemotherapy medication errors, chemotherapy ABSTRACT Background

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Section: Discussionmentioning

confidence: 73%

Computerized Prescriber Order Entry in the Outpatient Oncology Setting: From Evidence to Meaningful Use

et al. 2014

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“…However, the value of CDS is often limited by providers' lack of alert acceptance. Multiple studies have shown that providers frequently override alerts because they are perceived as irrelevant [39][40][41][42] . The inability of EHR systems to effectively present information for CDS purposes may contribute to the mixed safety benefits observed in studies 1,[7][8][9][10]12,13 .…”

Section: Discussionmentioning

confidence: 99%

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

et al. 2011

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BACKGROUND: 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. OBJECTIVE: 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. DESIGN, PARTICIPANTS: 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. MAIN MEASUREMENTS: Prescribing errors were identified by standardized prescription and chart review. A novel survey instrument was administered to evaluate provider perceptions about prescribing safety. KEY RESULTS: 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 postimplementation (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. CONCLUSIONS: 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. INTRODUCTIONImproving healthcare safety is a national priority, and eprescribing is viewed as an important tool in these efforts 1-2 . Research on the ability of e-prescribing to improve safety has predominantly come from the inpatient setting and on locally developed systems created by organizations for their own use 3-5 . Fewer studies have been conducted on commercial systems or in the outpatient setting and results have been mixed [6][7][8][9][10][11][12][13] . To ensure that federal spending is directed toward effective interventions, it is important to evaluate the effect of e-prescribing on safety in the ambulatory setting, where most prescribing occurs and errors are common 7,[12][13][14][15] .Use of e-prescribing in the ambulatory setting has been low, although increased use is expected given federal incentives for meaningful EHR use 2,[16][17][18][19][20] . To demonstrate meaningful use, providers will have to meet c...

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“…Paramount among these challenges is the question about the relevance and sensitivity of drug interaction or adverse-effect alerts. 54,55 The existing insensitivity results in many false-positive alerts and subsequently in override rates ranging from 89% to 91%. 25,[56][57][58] Although few studies have been published that assess this phenomenon in children, children tend to be on fewer chronic medications and, because of generally good renal and hepatic function, may be less at risk for severe adverse reactions, 59 thereby magnifying this concern in pediatrics.…”

Section: E-prescribing System Functional Requirementsmentioning

confidence: 99%

Electronic Prescribing in Pediatrics: Toward Safer and More Effective Medication Management

Johnson¹,

Lehmann²

2013

Pediatrics

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This technical report discusses recent advances in electronic prescribing (e-prescribing) systems, including the evidence base supporting their limitations and potential benefits. Specifically, this report acknowledges that there are limited but positive pediatric data supporting the role of e-prescribing in mitigating medication errors, improving communication with dispensing pharmacists, and improving medication adherence. On the basis of these data and on the basis of federal statutes that provide incentives for the use of e-prescribing systems, the American Academy of Pediatrics recommends the adoption of e-prescribing systems with pediatric functionality. This report supports the accompanying policy statement from the American Academy of Pediatrics recommending the adoption of e-prescribing by pediatric health care providers. Pediatrics 2013;131:e1350-e1356The US health care system has the distinction of being the world' s most expensive delivery system while also having among the lowest levels of quality, as judged by many metrics, including infant mortality, life expectancy, and potential years of life lost. 1,2 More specifically, despite US leadership in establishing many standards of care that correlate with improved quality, the US health care system is able to deliver, at best, 60% of the recommended care in most practices. 3,4 Reasons for this inefficiency include the voluminous information resources to consult and the experts' parallel processing and modeling skills (including integrating considerations of the patient' s other illnesses, lifestyle, and genome) required to make an optimal decision. 5 Other challenges include the health care system' s existing methods of payment, which lead to fragmented care. 6 Difficult-to-resolve health disparities also occur when there are suboptimal interactions between a person' s preferences, the regulatory/operational health care system, and internalized biases, stereotypes, or knowledge deficits. All of these challenges to information management affect the delivery of care. 7 For these reasons, health information technology (HIT) has become recognized as a set of tools that complement the provision of care. 8 Electronic prescribing (e-prescribing) is widely recognized as a component of the prescribing process that facilitates handoffs, improves clinical decision-making, and may improve medication adherence. E-prescribing was defined in 2008 by the Centers for Medicare and Medicaid Services as a system providing prescribers with

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Assessing the value of electronic prescribing in ambulatory care: A focus group study

Cited by 56 publications

References 22 publications

Computerized Prescriber Order Entry in the Outpatient Oncology Setting: From Evidence to Meaningful Use

Computerized Prescriber Order Entry in the Outpatient Oncology Setting: From Evidence to Meaningful Use

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

Electronic Prescribing in Pediatrics: Toward Safer and More Effective Medication Management

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