Variation in Electronic Prescribing Implementation Among Twelve Ambulatory Practices

Crosson, Jesse C.; Isaacson, Nicole; Lancaster, D. G.; McDonald, Emily A.; Schueth, Anthony J.; DiCicco-Bloom, Barbara; Newman, Joshua; Wang, C. Jason; Bell, Douglas S.

doi:10.1007/s11606-007-0494-8

Cited by 49 publications

(44 citation statements)

References 27 publications

(21 reference statements)

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“…Understanding the effects will be informative for those undergoing this type of transition and allow potential safety threats to be better managed 24,25 . We therefore conducted this study to 868 examine the effects on prescribing safety of transitioning between two systems in an academic-affiliated ambulatory practice.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

confidence: 99%

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

et al. 2011

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“…However, many of the articles in this issue address the fact that apportioning these potential benefits and how they are experienced over time are significant system factors affecting HIT implementation. [3][4][5] Consider the articles discussing electronic prescribing. 3,4 The aggregate system benefits are well established in terms of, for example, reducing adverse drug events, but the costs of the implementation are borne by those who implement and use e-prescribing.…”

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confidence: 99%

“…As a result, even when e-prescribing implementation is financially underwritten the perceived and real non-financial costs can cause failure. [2][3][4]6 However, the reporting of programs in Massachusetts 4 and New Jersey 3 that are piloting the apportionment of system-wide benefits to practices in the forms of implementation assistance are an encouraging connection of system-wide benefits to component parts (practices). Time is another important system consideration in HIT implementation.…”

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confidence: 99%

“…As mentioned above, despite widespread advocacy for electronic prescribing as a tool to improve patient, safety, only about one fifth of practices currently have implemented this technology. 3 Crosson et al 3 used observational and interview techniques to collect data on prescription-related clinical workflow, information technology experience and expectations in a sample of physicians and staff members in 12 practices scheduled for implementation of an e-prescribing program.…”

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confidence: 99%

“…Perhaps an even more important role may be to help practice managers identify areas where there is considerable variation in practice or multiple workarounds, which would be ideal targets of further research or a potential system redesign project. Leu et al 3 conclude that underlying workflows for the domains must be fully operational and further, that understanding clinical context is a necessary precursor to successful deployment of HIT. This study provides further evidence of the importance of understanding the local context and adapting implementation of HIT to overcome the local barriers.…”

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The Role of Systems Factors in Implementing Health Information Technology

Doebbeling

Pekny

2008

J GEN INTERN MED

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T his issue of the Journal of General Internal Medicine (JGIM) includes a variety of important articles on the different dimensions of the role of health information technology (HIT) in medical practice. Several of the articles provide key insights into issues which are important in the effective implementation of HIT to change practice. We have noted several key themes across this issue, which provide insights into future clinical and research directions needed to ensure the successful implementation of HIT to change practice. We start by taking a "system" perspective and then note some of the detailed factors affecting HIT implementation.An underlying theme of these articles is that HIT must be an integral part of the health care system and that being aware of the "system", its properties, its time-varying characteristics, its complexity, and the surroundings in which the system exists strongly influences the success of HIT. For example, Leu et al. 1 makes the key point that "Successful adoption of health IT requires an understanding of how clinical tasks and workflows will be affected; yet this has not been well described". That is, the probability of a successful HIT implementation is greatly increased by a well-characterized, deliberately designed host set of health care processes. Furthermore, expectations of HIT within a health care process must be realistic with respect to benefits and costs. White 2 makes several fundamental observations about the health care system and HIT. He notes that "so much medical care involves acquiring, sorting, categorizing, exchanging, imparting and using information for treatment decisions actions…". Although health care has many dimensions beyond information processing, the key role of information to health care provides an inescapable first-principles argument about the enormous potential system benefits of HIT. However, many of the articles in this issue address the fact that apportioning these potential benefits and how they are experienced over time are significant system factors affecting HIT implementation. [3][4][5] Consider the articles discussing electronic prescribing. 3,4 The aggregate system benefits are well established in terms of, for example, reducing adverse drug events, but the costs of the implementation are borne by those who implement and use e-prescribing. These costs are both financial and otherwise. As a result, even when e-prescribing implementation is financially underwritten the perceived and real non-financial costs can cause failure.

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