Posted by: AllinHIT
The Journal of the American Medical Informatics Association, this week published a report detailing error rates for ePrescribing is the same as manual paper scripts. This was stunning to ePrescribe advocates, vendors, and users, who thought an 11% error rate for paper scripts will reduce significantly. However, after reading the cliff notes, I was not surprised the report is useless.
Upon hearing the news and prior to reading the cliff notes, I immediately had many questions. What years were reviewed in the study? What are the particulars pertaining to sample size, geography, and applications used? After reading the cliff notes of the report, searching for these answers, I’ve deemed this study useless and here is why.
First, not all ePrescribe programs are created equal! According to the report, some application out-performed others, some had an error rate of 5%, others were as high as 38%. There are ePrescribe applications that are not “fully informed”. A “fully informed” application automatically and regularly updates manufacturing dosage information, and co-pay information, hence reducing errors in that regard. The report noted that this was responsible for 60% of the errors reported! Notably, physicians typically aren’t aware that their application is not fully informed, which tends to further discussion on the importance of selecting these applications, including EHR’s. Additionally, this study used data from 2008, prior to Meaningful Use effect on eprescribing, requiring a fully informed application. Secondly, it must be noted that patient allergy information, key to not generating contra-indications, is typically not tracked and updated, during the initial use of ePrescribing. Hence, this increases errors to the pharmacy side, whereas, allergies are most likely tracked in perspective pharmacy systems.
Lastly, when I read the study examined data from Florida, I reflected on my work with ePrescribe Florida, a successful public private partnership that increased the adoption of electronic prescribing in the State, as I profiled previously, https://searchhealthit.techtarget.com/healthitexchange/allthingshit/wp-admin/post.php?action=edit&post=60). This was a time, we were at the peak of our efforts, when there were considerable ePrescribe trails, ePrescribe training, and other efforts that could possibly increase user errors. As a ePrescribe Florida stakeholder, and a consultant and trainer for Quest Diagnostics, I spent many hours watching a user, not change the default dosage information, for a script that should of been changed. Maybe they thought the default dosage was intuitive to a patients condition and physician’s notes (sounds like a CDSS feature!). Regardless, there were high user errors in Florida during this period of time, making this report useless for me today.