Friday, January 30, 2009

ePrescribing Increases Errors

A recent report in the open-access journal BMC Biomedical Informatics and Decision Making describes the experience of 3 large pharmacies in Sweeden. They found, as have others, that a sizable fraction of prescriptions need clarification before they can be dispensed. "Clarification" means the pharmacist cannot safely and reliably fill the order without contacting the prescriber. This is a good practical definition of "error" in this setting. These errors represent re-work for the prescriber, delay in care for the patient, and increased costs to the system. Some of them also represent potentially dangerous actions that put the patient at risk for illness, injury or death.

One of the main reasons to change from hand-written prescriptions to ePrescribing is to reduce the need for clarifications and the errors they represent. Unfortunately, the Sweedish team found that ePrescriptions were substantially more likely to need clarification than the old-fashioned ones. 2.0% for the electronic scripts vs. 1.2% for the older type.

Many of the errors could be traced to lack of standardization across ePrescribing systems. The authors also called for more training of users. However, anytime a system requires extensive training, that means it has too many inherent failure modes. For ePrescribing to truly save lives and money, the interfaces to the users need to be intuitive, easy-to-use, and supportive of the user's tasks. Until then, ePrescribing, like Computerized-Provider-Order-Entry, will just be another failure mode.


  1. I'm curious about the conclusions reached here. If e-prescribing is done in a vacuum, I can see there being problems. However, e-prescribing, supported by decision support tools, clinical information about the patient, warnings about D-D interactions, warnings about medication allergies, and medication histories could potentially produce a very different result.

    I think that any piece of electronic information that is created without proper inputs and support is likely to be error-prone.

    But, if the IT people of the world and the holders of relevant data elements can work together, I think a completely different result may occur, as long as we are also dealing with providers who are properly trained to use the system and who are enthusiastic about such a system.

    That's a lot of conditions, but I think it's premature to write off e-prescribing.

  2. I agree completely. We should not write off e-prescribing. But, we shouldn't count on it until it actually does meet all the conditions you listed (and probably a few more).



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