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Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

  • Original Research
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Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

Healthcare providers previously using older electronic health records (EHRs) with electronic prescribing (e-prescribing) are transitioning to newer systems to be eligible for federal meaningful use incentives. Little is known about the safety effects of transitioning between systems.

OBJECTIVE

To assess the effect of transitioning between EHR systems on rates and types of prescribing errors, as well as provider perceptions about the effect on prescribing safety.

DESIGN, PARTICIPANTS

Prospective, case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009. All physicians transitioned from an older EHR with minimal clinical decision support (CDS) for e-prescribing to a newer EHR with more robust CDS.

MAIN MEASUREMENTS

Prescribing errors were identified by standardized prescription and chart review. A novel survey instrument was administered to evaluate provider perceptions about prescribing safety.

KEY RESULTS

We analyzed 1298 prescriptions at baseline, 1331 prescriptions 12 weeks post-implementation, and 1303 prescriptions one year post-implementation. Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions, 95% confidence interval (CI) 23.2–54.8) and lowest one year post-implementation (12.2 per 100 prescriptions, 95% CI 8.6–17.4) (p < 0.001). Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors. However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions, 95% CI 9.5–33.0 versus 8.5 per 100 prescriptions, 95% CI 4.6-15.9) (p <0.001) and no different at baseline than one year (10.2 per 100 prescriptions, 95% CI 6.2–18.6) (p = 0.337). Survey results complemented quantitative findings.

CONCLUSIONS

Results from this case study suggest that transitioning between systems, even to those with more robust CDS, may pose important safety threats. Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits.

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Acknowledgements

The authors thank Dr. Fran Ganz-Lord for her assistance enrolling physicians, and Drs. James Hollenberg and Curtis Cole for assistance in retrieving electronic data. This project was supported by the Agency for Healthcare Research and Quality (R18HS017029), Rockville, MD.

Funding/Support

This project was supported by the Agency for Healthcare Research and Quality (R18HS017029), Rockville, MD.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Weill Cornell Medical College, 402 East 67th Street, Room-LA-261, New York, NY, 10065, USA

    Erika L. Abramson MD, MS, S. Nena Osorio MD & Rainu Kaushal MD, MPH

  2. Department of Public Health, Weill Cornell Medical College, New York, NY, USA

    Erika L. Abramson MD, MS, Sameer Malhotra MD, MA, Alison Edwards MStat, Elizabeth R. Pfoh MPH & Rainu Kaushal MD, MPH

  3. New York-Presbyterian Hospital, New York, NY, USA

    Erika L. Abramson MD, MS, Karen Fischer RN, S. Nena Osorio MD, Adam Cheriff MD & Rainu Kaushal MD, MPH

  4. Health Information Technology Evaluation Collaborative (HITEC), New York, NY, USA

    Erika L. Abramson MD, MS, Sameer Malhotra MD, MA, Alison Edwards MStat, Elizabeth R. Pfoh MPH, S. Nena Osorio MD & Rainu Kaushal MD, MPH

  5. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Adam Cheriff MD & Rainu Kaushal MD, MPH

Authors
  1. Erika L. Abramson MD, MS
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  2. Sameer Malhotra MD, MA
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  3. Karen Fischer RN
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  4. Alison Edwards MStat
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  5. Elizabeth R. Pfoh MPH
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  8. Rainu Kaushal MD, MPH
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Corresponding author

Correspondence to Erika L. Abramson MD, MS.

Additional information

Trial Registration ClinicalTrials.gov, ID NCT00603070

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Abramson, E.L., Malhotra, S., Fischer, K. et al. Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety. J GEN INTERN MED 26, 868–874 (2011). https://doi.org/10.1007/s11606-011-1703-z

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  • DOI: https://doi.org/10.1007/s11606-011-1703-z

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