Surescripts' reaction to e-prescribing study doesn't erase the need for improvement

A recent paper published in the Journal of the American Medical Informatics Association (JAMIA) found that about one in 10 computer-generated prescriptions contained errors, and that two-thirds of those were errors of omission.

In a joint statement released shortly after the study's publication, Surescripts, the company that connects physicians' offices and pharmacies online, and the authors of the study--who hail from Harvard Medical School, Massachusetts General Hospital, CVS and Partners Healthcare--point out that the data used in the study came from computer-generated prescriptions that were printed out or faxed to pharmacies. Although this wasn't made clear in the study, none of the prescriptions in the study were transmitted online.  The statement observes that this does not reflect the current usage of the term "electronic prescribing," which now refers only to prescriptions that are sent online to pharmacies.

"Therefore," the statement says, "the results of the study should not be generalized to e-prescribing as there are clear and significant differences between these prescription transmission methods and the terms and technologies are not interchangeable."

While it's true that the multiple transmission methods aren't equivalent, that doesn't mean that the study's findings are inapplicable to prescriptions sent online. "We believe that our results apply regardless of mode of prescription transmission," stated the JAMIA paper.

One of the study authors says that that statement remains true. "The errors generated at the [computer] system level, before transmission occurs, are the same, regardless of mode of transmission," says Karen Caputo-Nanji, resident physician at Massachusetts General Hospital, department of anesthesia, critical care and pain medicine. "However, the various modes of transmission can lead to various other types of errors. We didn't look at anything that happens in the pharmacy after it receives the prescription. We were just looking at the system level."

Certain kinds of errors may occur if a prescription is hand-carried or computer-faxed to a pharmacy that would not be possible were it sent online to the drugstore's computer system. These kinds of mistakes, which were not measured in the JAMIA study, occur when pharmacists enter prescription information into their system inaccurately.

That said, the joint statement notes that there is room for improvement in e-prescribing, and the study makes some practical suggestions in that area. For example, it says, software vendors could add "forcing functions" that would not allow prescriptions to be completed if they contained omissions. Second, the researchers point out that better clinical decision support could help prevent errors related to dosage or frequency of the medication, which comprised 7.5 percent of the observed mistakes and 13.5 percent of the potential adverse drug events.

E-prescribing programs have undoubtedly improved since 2008, when the study was performed. But to the extent that some of these applications still fall short, there should be a system that ensures they come up to the mark, and clinicians should be trained to use them properly. - Ken

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