An electronic health record (EHR) system helped reduce prescription errors of physicians in a New York City clinic, but doctors found transitioning to the electronic records difficult, according to a study in the Journal of General Internal Medicine (April 16, 2011).
As the U.S. government invests billions of dollars to encourage healthcare providers to use EHR systems, many providers will switch from older systems to new systems to qualify for the federal incentives. But whether the upgrade improves patient care and safety remains unanswered.
To address this issue, a team of physician-scientists from Weill Cornell Medical College in New York City tracked the prescription errors of 19 physicians in an adult ambulatory clinic before the switch from an older to a newer system, then after 12 weeks and again a year later.
The new EHR system provided guidance for prescribing to improve safety, such as alerts notifying providers about use of inappropriate abbreviations that can result in patient harm, as well as checks for drug-allergy interactions, drug-drug interactions, and duplicate drugs.
The researchers analyzed nearly 4,000 prescriptions for more than 2,000 patients and noted mistakes in abbreviations, usage directions, dosage, and the quantity of medications to be dispensed. They also surveyed physicians' views of the switch.
They found that the rate of prescription errors dropped by two-thirds, from about 36% to about 12% a year later. They also found that the rate of improper abbreviations, such as the outmoded "QD" instead of "once daily," fell by three-quarters, from about 24% to about 6% a year later. Meanwhile, the rate of nonabbreviation errors rose from about 9% to about 18% 12 weeks later, but it declined to the baseline level after one year.
Senior author Rainu Kaushal, MD, chief of the division of quality and medical informatics in the departments of pediatrics and public health at Weill Cornell Medical College, cautioned that changing from one system to another, even among providers that are used to EHRs, can be problematic.
For example, 40% of the doctors in this study weren't satisfied with the implementation of the new system, and only one-third thought it was safer than the old one. In particular, 60% reported that the alerts weren't useful, and two-thirds indicated that the new system slowed down drug orders and refills.
