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The comparative effectiveness of 2 electronic prescribing systems.
Rainu Kaushal1, Yolanda Barron, Erika L Abramson
1Department of Pediatrics, Weill Cornell Medical College, 525 E 68th Street, New York, NY 10065, USA.
The American Journal of Managed Care
|January 6, 2012
Summary
A standalone electronic prescribing (e-prescribing) system significantly reduced medication errors compared to an integrated system. This highlights the importance of robust clinical decision support for improving medication safety in healthcare delivery.
Area of Science:
- Health Services Research
- Medical Informatics
- Comparative Effectiveness Research
Background:
- Electronic health records (EHRs) are transforming healthcare delivery.
- The comparative effectiveness of different electronic prescribing (e-prescribing) systems is not well understood.
- Medication safety is a critical aspect of healthcare quality impacted by technology.
Purpose of the Study:
- To compare the impact of two distinct e-prescribing systems on medication prescribing error rates.
- To illustrate the application of comparative effectiveness research (CER) in evaluating healthcare delivery components.
- To assess the influence of clinical decision support (CDS) and technical resources on e-prescribing system performance.
Main Methods:
- Conducted two non-randomized, prospective studies with pre-post controls.
- Compared prescribing errors between providers using a standalone e-prescribing system with robust CDS and an EHR-integrated system with less robust CDS.
- Utilized identical methodology including prescription and chart reviews for ambulatory care providers.
Main Results:
- The standalone system reduced prescribing errors from 42.5 to 6.6 per 100 prescriptions (P <.001).
- The integrated system reduced errors from 26.0 to 16.0 per 100 prescriptions (P = .07).
- Adjusted analysis showed standalone users had a 4-fold lower error rate at 1 year (P <.001).
Conclusions:
- Standalone e-prescribing systems with robust CDS may offer superior medication safety compared to integrated systems with less support.
- Differences in CDS and technical resources significantly impact e-prescribing system performance.
- This study underscores the value of CER in directly comparing healthcare delivery technologies and components.
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