Transitioning to new electronic health records can result in potential safety problems
Research Activities, December 2011, No. 376
Federal incentives for meaningful use of electronic health records (EHRs) are prompting many health care providers to upgrade from older EHR systems. The incentives require newer systems to include electronic prescribing (e-prescribing) capabilities. However, transitioning to newer technology may result in some unexpected effects on prescribing safety. A recent case study has found that safety issues can occur 12 weeks into implementation of a new system.
The study involved 17 physicians practicing at an academic ambulatory clinic. During an 18-month period, they transitioned from an older EHR system with minimal clinical decision support (CDS) for e-prescribing to a newer system with expanded e-prescribing capabilities. Researchers reviewed prescriptions and patient charts to identify prescribing errors at baseline, 12 weeks after implementation of the new system, and then again 1 year later.
Rates of prescribing errors were highest at baseline (35.7 per 100 prescriptions). At one year, however, this rate was significantly lower (12.2 per 100 prescriptions). No differences were observed among the time periods for rates of near misses and rule violations. In addition, no preventable adverse drug events were identified.
The majority of prescribing errors during all three time periods involved the inappropriate use of abbreviations. These were highest at baseline (24.1 per 100 prescriptions). However, since the newer system automatically corrected for these, the rate dropped to 10.6 at 12 weeks and 5.9 after 1 year. The researchers then excluded inappropriate abbreviation errors in a separate analysis. As a result, the non-abbreviation prescribing error rate was lowest at baseline (8.5) and highest at 12 weeks (17.7). After a year of implementation, there was no significant difference in the error rate compared to baseline.
Physicians had mixed reactions to implementation of the new system. Only a third felt the newer system improved safety over the older system. Two-thirds felt that the speed in ordering and refilling medications was slower with the new system. The researchers suggest that vendors tailor the design of the CDS to promote more safety gains. This might mean focusing on certain types of errors. Such strategies should be combined with additional provider education. The study was supported in part by the Agency for Healthcare Research and Quality (HS17029).
See "Transitioning between electronic health records: Effects on ambulatory prescribing safety," by Erika L. Abramson, M.D., M.S., Sameer Malhotra, M.D., M.A., Karen Fischer, R.N., and others in the Journal of General Internal Medicine 26(8), pp. 868-874, 2011.