Errors Lurk in Switch to E-Prescribing

Transitioning to more advanced e-prescribing systems could lead to a rise in drug errors that threaten patient safety.

Electronic prescribing has been viewed as a means to reduce errors and improve patient safety, but few studies have investigated the effects of the sometimes rocky transition from older to newer electronic health records (EHR) systems. As more health care providers take the plunge, however, many are seeing an increase in certain types of medication errors, according to a new study.

The research showed that newer systems for e-prescribing effectively lower prescription error rates, but not without a temporary increase in errors that could harm patients. Lead author Rainu Kaushal, MD, MPH, of New York’s Weill Cornell Medical College, said the results indicate that “transitioning between systems, even among providers that are used to electronic health records, can be problematic.”

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For the study, Dr. Kaushal and colleagues tracked prescription errors of 19 physicians in an ambulatory clinic that transitioned from an older EHR—with minimal clinical decision support for e-prescribing—to a newer, more advanced EHR. The new system alerted physicians about the use of inappropriate abbreviations and performed checks for drug allergies, drug-drug interactions, and duplicate drugs.

Although the overall rate of prescribing errors dropped from 35.7% to 12.2% within a year of implementing the new EHR, the rate of nonabbreviation prescribing errors doubled in the first 12 weeks of the transition—increasing from 8.5% to 17.7%. When the researchers followed up again in a year, however, the rate of nonabbreviation errors had settled at 10.2%.

Based on the results, researchers concluded that the adjustment period between systems “may pose important safety threats,” and that more effort is needed to make the new systems easier to use. Supporting physicians with ongoing training and guidance is another important piece of the puzzle, the authors wrote. In an accompanying survey, 40% of participating physicians said they weren’t satisfied with how the new system was implemented.

Dr. Kaushal said these findings shouldn’t discourage health care providers from updating their e-prescribing systems, however, since “on the good side we found that the new system was very effective at reducing certain types of prescribing errors, such as inappropriate abbreviation errors.” A reduction in these types of errors would likely translate to “fewer callbacks from pharmacies and improved efficiencies,” she said.

The results were published online April 16, 2011, in the Journal of General Internal Medicine.

For other articles in this issue, see:

• "Polypill" Shows Promise for Heart Patients
• 3 Steps to Better Medication Management