An unintended consequence of electronic prescriptions: prevalence and impact of internal discrepancies
- Matvey B Palchuk1,2,
- Elizabeth A Fang2,3,
- Janet M Cygielnik2,
- Matthew Labreche4,
- Maria Shubina2,
- Harley Z Ramelson1,2,
- Claus Hamann1,2,
- Carol Broverman2,
- Jonathan S Einbinder1,2,
- Alexander Turchin1,2
- 1Harvard Medical School, Boston, Massachusetts, USA
- 2Partners HealthCare System, Inc, Boston, Massachusetts, USA
- 3The Johns Hopkins Hospital, Baltimore, Maryland, USA
- 4Northeastern University, Boston, Massachusetts, USA
- Correspondence to Dr Alexander Turchin, Clinical Informatics Research and Development, Suite 201, 93 Worcester Street, Wellesley, MA 02481, USA; aturchin{at}partners.org
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Contributors Supported in part by a grant from Partners HealthCare IS Research Council.
- Received 7 August 2009
- Accepted 3 May 2010
Abstract
Many e-prescribing systems allow for both structured and free-text fields in prescriptions, making possible internal discrepancies. This study reviewed 2914 electronic prescriptions that contained free-text fields. Internal discrepancies were found in 16.1% of the prescriptions. Most (83.8%) of the discrepancies could potentially lead to adverse events and many (16.8%) to severe adverse events, involving a hospital admission or death. Discrepancies in doses, routes or complex regimens were most likely to have a potential for a severe event (p=0.0001). Discrepancies between structured and free-text fields in electronic prescriptions are common and can cause patient harm. Improvements in electronic medical record design are necessary to minimize the risk of discrepancies and resulting adverse events.
Footnotes
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Competing interests None.
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Ethics approval This study was conducted with the approval of the Partners HealthCare Institutional Review Board.
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Provenance and peer review Not commissioned; externally peer reviewed.
