Is electronic medication management in ambulatory care safe?

There's been little study of the safety implications of electronic medication management in ambulatory care, according to research published at BMC Medical Informatics and Decision Making.

In a literature review, a research team from Norway searched nine databases for studies on the implementation of electronic systems such as electronic prescribing, clinical decision support (CDS) and electronic health records, looking for evidence to support claims that these systems can introduce new patient safety issues.

They found few studies dealt with adverse events in medication management. Of 4,056 titles and abstracts initially screened, they found just 38 full-text articles to include in the review. Of them, 18 papers on randomized controlled trials and five on non-randomized controlled trials did not report any adverse events.

In 15 observational studies, adverse events occurred less often after implementation of CDS. One randomized controlled trial and one observational study reported an increase in problematic prescriptions with electronic prescribing.

User interface, faulty programming and erroneous information in the CDS application were problems that lead to erroneous prescribing. Several of the studies linked errors with override of decision support advice.

Many randomized controlled trials were not monitoring for adverse events and even if they were, they often did not reveal rare outcomes or have long-enough followup.

"Investigators conducting studies of the effect of organizational interventions should power their studies and length of follow-up to capture rare, unintended and unsuspected events and publish these findings regardless of statistical significance," the authors wrote. "Even anecdotal reports of observed risks to patient safety and adverse events can inform future study hypotheses and design."

One of the studies in a recent special issue of The American Journal of Managed Care found that medication management, as required by Meaningful Use, does reduce adverse events and cut costs.

New Jersey-based primary-care practice Vanguard Medical Group cites technology as key to its efforts to improve care transitions, including better medication management.

And the Agency for Healthcare Research and Quality (AHRQ) is touting results from 10 research projects aimed at using health IT to improve care in ambulatory settings for patients with complex healthcare needs. The projects tackled a range of issues, including medication management, heart disease, mental illness and frailty associated with old age.

To learn more:
- find the research(.pdf)

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