Electronic prescribing decreases prescription errors

Should doctors around the country use e-prescribing to decrease prescription errors? A study led by physician-scientists from Weill Cornell Medical College found that health care providers using an electronic system to write prescriptions were seven times less likely to make errors than those writing their prescriptions by hand. The study appears today in the online edition of the Journal of General Internal Medicine.

There is currently a strong push in the United States to encourage doctors to write electronic prescriptions in the ambulatory setting, where an estimated 2.6 billion drugs are provided, prescribed or continued. According to the study's authors, demonstrating improvements in safety with electronic prescribing is important to encourage its use, especially among community providers in solo and small group practices who mostly write prescriptions by hand.

"We found nearly two in five handwritten prescriptions in these community practices had errors," says Dr. Rainu Kaushal, the study's lead author and associate professor of pediatrics, medicine and public health, and chief of the Division of Quality and Medical Informatics at Weill Cornell Medical College. "Examples of the types of errors we found included incomplete directions and prescribing a medication but omitting the quantity. A small number of errors were more serious, such as prescribing incorrect dosages."

"Although most of the errors we found would not cause serious harm to patients, they could result in callbacks from pharmacies and loss of time for doctors, patients and pharmacists," says senior author Dr. Erika Abramson, assistant professor of pediatrics at Weill Cornell Medical College and a pediatrician at the Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "On the plus side, we found that by writing prescriptions electronically, doctors can dramatically reduce these errors and therefore these inefficiencies."

"At a time when the federal government and many state governments, led by New York state, are pushing for increased use of information technology to improve the delivery of health care, it is important that physicians are aware of how technology like electronic prescribing systems can improve the safety and value of care they give patients," says Dr. Kaushal, who is also director of pediatric quality and safety for the Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "It is also important that electronic prescribing systems are easy for health care providers to use, fit well into their workflow, and that providers have technical assistance to help them install and maintain these systems."

To evaluate the effects of e-prescribing on medication safety, researchers looked at prescriptions written by health care providers at 12 community practices in the Hudson Valley region of New York. The authors compared the number and severity of prescription errors between 15 health care providers who adopted e-prescribing and 15 who continued to write prescriptions by hand.

The providers who adopted e-prescribing used a commercial, stand-alone system that provides dosing recommendations and checks for drug-allergy interactions, drug-drug interactions and duplicate drugs. All the practices that adopted e-prescribing received technical assistance from MedAllies, a health information technology service provider. The study noted that, without extensive technical support, it is difficult for physician practices to achieve high rates of use of electronic prescribing and subsequent improvements in medication safety.

In total, the authors reviewed 3,684 paper-based prescriptions at the start of the study and 3,848 paper-based and electronic prescriptions written one year later. After one year, the percentage of errors dropped from 42.5 percent to 6.6 percent for the providers using the electronic system. For those writing prescriptions by hand, the percentage of errors increased slightly from 37.3 percent to 38.4 percent. Illegibility problems were completely eliminated by e-prescribing.