CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting

Abstract

Objective Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic’s electronic health record (EHR) to the outpatient pharmacy’s software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software. Materials and Methods CancelRx was implemented in October 2017 at an academic health system. For 12 months prior, and 12 months after CancelRx implementation, data were collected on discontinued medications in the health system’s EHR and whether those prescriptions were successfully discontinued in the pharmacy’s dispensing software. An interrupted time series analysis was conducted to model the occurrence of prescriptions successfully discontinued over time. Results There was an immediate (lag = 0), significant (P < 0.001), and sustained (post-implementation slope 0.02) increase in the proportion of successful medication discontinuations after CancelRx implementation (from 34% to 93%). CancelRx had variable impact based on whether the clinic was primary care (71.4% change prepost) or specialty care (53.9% change prepost). CancelRx reduced the time between when a medication was discontinued in the clinic EHR and pharmacy dispensing software. Conclusion CancelRx automated a manual process and illustrated the role for health IT in communicating medication discontinuations between clinics and pharmacies. Overall, CancelRx had a marked benefit on medication list discrepancies and illustrated how health IT can be used across different settings to improve patient care.

CancelRx implementation: Observed changes to medication discontinuation workflows over time

“…Although there has been research to demonstrate how CancelRx affects health system outcomes, such as reducing medication list discrepancies, little is known about how this novel health IT affected the medication discontinuation workflow for pharmacy staff and how these processes changed over time after implementation. 3 , 4 …”

Underuse of Electronic Health Record Features—The Case for CancelRx

“…However, in 2017, Surescripts removed these financial restraints, which helped with some adoption. 5 CancelRx also experienced a "chicken-and-egg" syndrome in which many pharmacies declined to activate the functionality because there were not many prescribers sending CancelRx messages. Many prescriber organizations in turn would not activate the Can-celRx functionality because there were not many pharmacies able to receive their CancelRx messages.…”

“…6 Although not frequently published, several organizations have successfully used CancelRx, such as the University of Wisconsin-Madison and Johns Hopkins Health System. 5,7…”

Impact of CancelRx on discontinuation of controlled substance prescriptions: an interrupted time series analysis

“…In a pilot study, Pitts et al demonstrated that CancelRx functionality successfully discontinued medications in the pharmacy’s dispensing software that had been discontinued in the prescriber’s EHR 92.4% of the time [ 23 ]. Similarly, a study by Chui et al, showcased not only a 93% success rate for CancelRx communication medication discontinuations, but also a drastic reduction in the amount of time required for a medication to be discontinued in the pharmacy software after it was discontinued at the clinic [ 24 ].…”