Commercial e-prescribing systems a script for better health

Commercial electronic prescribing, or e-prescription, systems have the potential to dramatically reduce prescribing error rates, a new University of New South Wales study has found.

The before and after study, Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients, assessed e-prescribing systems implemented at two major teaching hospitals in Sydney.

In the study’s review of 3291 patient records for procedural errors such as incomplete or unclear medication orders, clinical errors, wrong dose or wrong drug, commercial e-prescribing systems were found to be associated with a “statistically significant reduction in total prescribing error rates by more than 55 per cent, driven by the substantial reductions in incomplete, illegal, and unclear orders.”

“While there was little change in the rate of clinical errors for the intervention wards (and an increase in one intervention ward), the rate of serious prescribing errors decreased by 44 per cent relative to the Hospital A control wards, which experienced a decline of 17 per cent,” the research found.

“Thus, while these e-prescribing systems with limited decision support were not associated with a substantial reduction in the rate of clinical errors, they were associated with a reduction in some of the most potentially serious errors.”

A central theme of the study, according to its authors, is that while in-house developed e-prescribing systems have been shown to reduce medication errors for more than a decade, a question mark has existed over whether commercial e-prescribing systems can deliver the same benefits.

The new research, which finds a fall in prescribing error rates of between 58 and 66 per cent across three test wards when compared to three control wards at the two Sydney hospitals, would suggest the question to be moot.

However, while the study’s authors argue that the research provides persuasive evidence of the current and potential value of commercial e-prescribing systems to reduce prescribing errors in hospital inpatients, they also caution that other studies have shown the success of e-prescribing systems are dependent on many contextual and organisational factors.

“Our qualitative studies at the study sites revealed clinicians’ greatest concern regarding the introduction of e-prescribing systems was the associated work practice changes, and qualitative and observational studies may best identify the nature of these changes,” the research found.

“Experience has shown that embedding systems into everyday practice is a long-term project. Importantly, the results highlight the need to continually monitor and refine the design of these systems to increase their capacity to improve both the safety and appropriateness of medication use in hospitals.”

Meanwhile, advancing e-health in other areas of the medical system have remained challenging. Last week, the Australian Medical Association (AMA) continued to lobby the government to change its $466.7 million e-health record system to an “opt-out” model, arguing that the current “opt-in” model will undermine the system’s health improvement objectives.

Last week the National E-Heath Transition Authority (NEHTA) also halted its implementation of primary care desktop software development at a number of lead implementation sites for the $466.7 million Personally Controlled Electronic Health Record (PCEHR) project.

Earlier in the month, NEHTA also said it would maintain its current design for personal e-health records despite acknowledging concerns that increased consumer control over health information could potentially result in poorer health outcomes for patients.

Follow Tim Lohman on Twitter: @Tlohman

Follow Computerworld Australia on Twitter: @ComputerworldAU

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