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Clinical Observation | Health Care Reform

Clinicians' Assessments of Electronic Medication Safety Alerts in Ambulatory Care

Saul N. Weingart, MD, PhD; Brett Simchowitz, BA; Lawrence Shiman, MPP; Daniela Brouillard, BA; Adrienne Cyrulik, MPH; Roger B. Davis, ScD; Thomas Isaac, MD, MPH, MBA; Michael Massagli, PhD; Laurinda Morway, MEd; Daniel Z. Sands, MD, MPH; Justin Spencer, MPA; Joel S. Weissman, PhD
Arch Intern Med. 2009;169(17):1627-1632. doi:10.1001/archinternmed.2009.300.
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Background  While electronic prescribing (e-prescribing) systems with drug interaction and allergy alerts promise to improve medication safety in ambulatory care, clinicians often override these safety features. We undertook a study of respondents' satisfaction with e-prescribing systems, their perceptions of alerts, and their perceptions of behavior changes resulting from alerts.

Methods  Random sample survey of 300 Massachusetts ambulatory care clinicians who used a commercial e-prescribing system.

Results  A total of 184 respondents completed the survey (61%). Respondents indicated that e-prescribing improved the quality of care delivered (78%), prevented medical errors (83%), and enhanced patient satisfaction (71%) and clinician efficiency (75%). In addition, 35% of prescribers said that electronic alerts caused them to modify a potentially dangerous prescription in the last 30 days. They suggested that alerts also led to other changes in clinical care: counseling patients about potential reactions (49% of respondents), looking up information in medical references (44%), and changing the way a patient was monitored (33%). Altogether, 63% of clinicians reported taking action other than discontinuing or modifying an alerted prescription in the previous month in response to alerts. Despite these benefits, fewer than half of respondents were satisfied with drug interaction and allergy alerts (47%). Problems included alerts triggered by discontinued medications (58%), alerts that failed to account for appropriate drug combinations (46%), and excessive volume of alerts (37%).

Conclusion  Although clinicians were critical of the quality of e-prescribing alerts, alerts may lead to clinically significant modifications in patient management not readily apparent based on “acceptance” rates.

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Figure 1.

Responses to the survey question “Think back to the time when you began to use electronic prescribing. How important were each of the following reasons in your decision to begin using electronic prescribing?” Clinicians were presented with 15 reasons that emerged in focus group discussions and were asked to select from a 4-point Likert scale ranging from very important to not important at all, or to select not applicable. Respondents endorsed a number of factors as influential in their decisions to adopt electronic prescribing, including a desire to reduce medication errors, to prevent errors associated with illegible prescriptions, and to improve the efficiency of their office practices.

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Figure 2.

Responses to the survey question “How would you rate the following features of the electronic prescribing system that you use?” Clinicians were presented with 10 features of the electronic prescribing system and asked to select from a 4-point Likert scale ranging from excellent to poor. Respondents rated highly a number of features. Most clinicians reported that the technology made renewing existing prescriptions particularly easy.

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Figure 3.

Responses to the survey question “In the last 30 days, how often has a drug allergy or interaction alert caused you to do any of the following?” Clinicians were presented with 9 behaviors that emerged in focus group discussions as potential reactions to electronic alerts and asked to select from a 4-point Likert scale ranging from often to never. Respondents endorsed the idea that medication safety alerts not only caused prescribers to alter or cancel prescriptions, but also resulted in actions that were not immediately evident based on alert acceptance rates.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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