E-prescriptions cut medication errors: study

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Doctors who trade in their prescription pads for electronic prescribing systems may be able to significantly cut down on medication errors, a small study suggests.

Researchers found that among 12 New York State primary care practices, the six that had adopted “e-prescribing” systems reduced their prescribing errors by nearly seven-fold over one year. Errors included mistakes like giving patients the wrong dose, wrong duration of use or incorrect or missing usage directions.

Electronic prescribing has been widely seen as a way to improve efficiency, save money and cut medication errors, such as cases where a pharmacy dispenses the wrong drug due to a doctor’s illegible handwriting. The systems also typically provide doctors with a drug’s allergy warnings, potential for interacting with other medications and other information that could help prevent adverse effects.

President Barack Obama has promoted greater use of e-prescribing and electronic patient records as part of healthcare reform, and the economic stimulus package passed last year included funds to encourage more doctors to adopt e-prescribing—which as of 2009, only an estimated 13 percent of U.S. doctors had done.

But it is unclear how the commercially available e-prescribing systems have so far performed in the real world, in solo and small-group medical practices, according to the researchers on the new study, led by Dr. Rainu Kaushal of Weill Cornell Medical College in New York City.

To study the question, the researchers focused on a dozen small practices in a largely suburban and rural area of New York. According to their report in the Journal of General Internal Medicine, half of the practices adopted e-prescribing systems, while the other six stayed with paper prescribing.

Kaushal’s team found that over one year, the e-prescribing practices cut their average prescribing error rate from 42.5 per 100 prescriptions to 6.6 for every 100 prescriptions.

In contrast, practices that stayed with paper saw their error rate remain nearly the same; at the outset, about 37 percent of prescriptions contained an error, and one year later that figure was 38 percent.

As expected, e-prescribing eliminated the problem of poor handwriting, Kaushal’s team found. At the outset, 88 percent of written prescriptions from practices that adopted e-prescribing had some illegible information, according to the researchers.

There was no significant improvement, the researchers found, in the rate of “near misses”—potentially harmful errors that were either caught or reached patients but did not cause serious problems. Among e-prescribers, such errors were seen in almost 1.5 percent of prescriptions at the outset, and in 1.3 percent one year later.

The rate of near misses increased, however, at practices that stuck with paper prescriptions—from 1 percent to nearly 3 percent.

“Our study is one of the first to demonstrate a reduction in prescribing errors in ambulatory solo and small group community practices, where e-prescribing adoption and usage has lagged,” Kaushal and her colleagues write.

The study has a number of limits, including the small number of doctors involved, the researchers note. The practices were also all using the same e-prescribing system, from the health information service provider MedAllies.

“Future studies,” the researchers write, “should be performed with more providers, at diverse sites, and with multiple systems.”

The study was funded by the federal Agency for Healthcare Research and Quality.

SOURCE: Journal of General Internal Medicine, online February 26, 2010.

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