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Research Letter | Less Is More

Generic Medication Prescription Rates After Health System–Wide Redesign of Default Options Within the Electronic Health Record

Mitesh S. Patel, MD, MBA, MS1,2; Susan C. Day, MD, MPH2; Scott D. Halpern, MD, PhD2; C. William Hanson, MD2; Joseph R. Martinez, BS2; Steven Honeywell Jr, BS2; Kevin G. Volpp, MD, PhD1,2
[+] Author Affiliations
1Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
2Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Intern Med. 2016;176(6):847-848. doi:10.1001/jamainternmed.2016.1691.
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This study examines prescription data from the University of Pennsylvania Health System outpatient clinics to compare generic medication prescription rates before and after a redesign of the electronic health record display defaults.

The growing adoption of the electronic health record (EHR) brings new opportunities to improve physician decision making toward higher-value care.1 Default options, or the conditions that are set into place unless an alternative is actively chosen, have been shown to influence decisions in many contexts.2 However, the effectiveness of different ways of implementing defaults has not been systematically examined in health care, and many people may assume that changing defaults is a one size fits all intervention that will always have the same effect.2 In prior work, changing the design of EHR medication display defaults for internal medicine physicians increased generic prescribing rates by 5.4 percentage points.3 In that intervention, the process of searching for a brand-name medication changed from displaying a list of brand-name options followed by their generic equivalents to displaying only generic-equivalent options. To view brand names, a physician had to click on another tab. In November 2014, the University of Pennsylvania Health System implemented a different change in EHR defaults among all specialties across the entire health system. Instead of changing EHR display defaults, an opt-out checkbox labeled “dispense as written” was added to the prescription screen, and if left unchecked the generic-equivalent medication was prescribed. The objective of this study was to evaluate the effect of this intervention on physician prescribing behaviors.

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Medications Prescribed as Generic by Drug Class and Month

Data presented are percent of medications prescribed as generic by month from January 2014 to June 2015 for each of the represented drug classes. The vertical gray line represents the intervention in mid-November.

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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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