J Am Med Inform Assoc - A long-term follow-up evaluation of electronic health record prescribing safety.

Tópicos

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Resumo

JECTIVE: To be eligible for incentives through the Electronic Health Record (EHR) Incentive Program, many providers using older or locally developed EHRs will be transitioning to new, commercial EHRs. We previously evaluated prescribing errors made by providers in the first year following transition from a locally developed EHR with minimal prescribing clinical decision support (CDS) to a commercial EHR with robust CDS. Following system refinements, we conducted this study to assess the rates and types of errors 2 years after transition and determine the evolution of errors.MATERIALS AND METHODS: We conducted a mixed methods cross-sectional case study of 16 physicians at an academic-affiliated ambulatory clinic from April to June 2010. We utilized standardized prescription and chart review to identify errors. Fourteen providers also participated in interviews.RESULTS: We analyzed 1905 prescriptions. The overall prescribing error rate was 3.8 per 100 prescriptions (95% CI 2.8 to 5.1). Error rates were significantly lower 2 years after transition (p<0.001 compared to pre-implementation, 12 weeks and 1 year after transition). Rates of near misses remained unchanged. Providers positively appreciated most system refinements, particularly reduced alert firing.DISCUSSION: Our study suggests that over time and with system refinements, use of a commercial EHR with advanced CDS can lead to low prescribing error rates, although more serious errors may require targeted interventions to eliminate them. Reducing alert firing frequency appears particularly important. Our results provide support for federal efforts promoting meaningful use of EHRs.CONCLUSIONS: Ongoing error monitoring can allow CDS to be optimally tailored and help achieve maximal safety benefits.CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov, Identifier: NCT00603070.

Resumo Limpo

jectiv elig incent electron health record ehr incent program mani provid use older local develop ehr will transit new commerci ehr previous evalu prescrib error made provid first year follow transit local develop ehr minim prescrib clinic decis support cds commerci ehr robust cds follow system refin conduct studi assess rate type error year transit determin evolut errorsmateri method conduct mix method crosssect case studi physician academicaffili ambulatori clinic april june util standard prescript chart review identifi error fourteen provid also particip interviewsresult analyz prescript overal prescrib error rate per prescript ci error rate signific lower year transit p compar preimplement week year transit rate near miss remain unchang provid posit appreci system refin particular reduc alert firingdiscuss studi suggest time system refin use commerci ehr advanc cds can lead low prescrib error rate although serious error may requir target intervent elimin reduc alert fire frequenc appear particular import result provid support feder effort promot meaning use ehrsconclus ongo error monitor can allow cds optim tailor help achiev maxim safeti benefitsclin trial registr clinicaltrialsgov identifi nct

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