JGIM: EHR transitions pose safety issues
Transitioning between EHR systems, even those with substantial clinical decision support (CDS), may pose important safety threats, according to a recent study published online in the Journal of General Internal Medicine.
Erika L. Abramson, MD, MS, of the department of pediatrics at Weill Cornell Medical College in New York City, and colleagues sought to assess the effect of transitioning between EHR systems on the rates and types of prescribing errors, and to gauge provider perceptions about the effect on prescribing safety.
Prescribing errors were identified by standardized prescription and chart review while a survey instrument was administered to evaluate provider perceptions about prescribing safety. Via a prospective case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009, the researchers analyzed 1,298 prescriptions at baseline, 1,331 prescriptions 12 weeks after implementation and 1,303 prescriptions one year post-implementation.
“All physicians transitioned from an older EHR with minimal CDS for e-prescribing to a newer EHR with more robust CDS,” Abramson and colleagues wrote. “The new electronic system provided extra 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.”
Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions) and lowest one year post-implementation (12.2 per 100 prescriptions). “Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors,” the researchers wrote. “However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions vs. 8.5 per 100 prescriptions) and no different at baseline than one year (10.2 per 100 prescriptions)."
To smooth the transition and further reduce prescription errors, the systems should be designed to detect and fix the most typical mistakes, as well as focus on the most clinically important mistakes so that providers don't begin to ignore alerts whenever they appear, the researchers suggested. “Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits,” they concluded.
Erika L. Abramson, MD, MS, of the department of pediatrics at Weill Cornell Medical College in New York City, and colleagues sought to assess the effect of transitioning between EHR systems on the rates and types of prescribing errors, and to gauge provider perceptions about the effect on prescribing safety.
Prescribing errors were identified by standardized prescription and chart review while a survey instrument was administered to evaluate provider perceptions about prescribing safety. Via a prospective case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009, the researchers analyzed 1,298 prescriptions at baseline, 1,331 prescriptions 12 weeks after implementation and 1,303 prescriptions one year post-implementation.
“All physicians transitioned from an older EHR with minimal CDS for e-prescribing to a newer EHR with more robust CDS,” Abramson and colleagues wrote. “The new electronic system provided extra 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.”
Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions) and lowest one year post-implementation (12.2 per 100 prescriptions). “Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors,” the researchers wrote. “However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions vs. 8.5 per 100 prescriptions) and no different at baseline than one year (10.2 per 100 prescriptions)."
To smooth the transition and further reduce prescription errors, the systems should be designed to detect and fix the most typical mistakes, as well as focus on the most clinically important mistakes so that providers don't begin to ignore alerts whenever they appear, the researchers suggested. “Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits,” they concluded.