A long-term follow-up evaluation of electronic health record prescribing safety

J Am Med Inform Assoc. 2013 Jun;20(e1):e52-8. doi: 10.1136/amiajnl-2012-001328. Epub 2013 Apr 11.


Objective: To be eligible for incentives through the Electronic Health Record (EHR) Incentive Program, many providers using older or locally developed EHRs will be transitioning to new, commercial EHRs. We previously evaluated prescribing errors made by providers in the first year following transition from a locally developed EHR with minimal prescribing clinical decision support (CDS) to a commercial EHR with robust CDS. Following system refinements, we conducted this study to assess the rates and types of errors 2 years after transition and determine the evolution of errors.

Materials and methods: We conducted a mixed methods cross-sectional case study of 16 physicians at an academic-affiliated ambulatory clinic from April to June 2010. We utilized standardized prescription and chart review to identify errors. Fourteen providers also participated in interviews.

Results: We analyzed 1905 prescriptions. The overall prescribing error rate was 3.8 per 100 prescriptions (95% CI 2.8 to 5.1). Error rates were significantly lower 2 years after transition (p<0.001 compared to pre-implementation, 12 weeks and 1 year after transition). Rates of near misses remained unchanged. Providers positively appreciated most system refinements, particularly reduced alert firing.

Discussion: Our study suggests that over time and with system refinements, use of a commercial EHR with advanced CDS can lead to low prescribing error rates, although more serious errors may require targeted interventions to eliminate them. Reducing alert firing frequency appears particularly important. Our results provide support for federal efforts promoting meaningful use of EHRs.

Conclusions: Ongoing error monitoring can allow CDS to be optimally tailored and help achieve maximal safety benefits.

Clinical trials registration: ClinicalTrials.gov, Identifier: NCT00603070.

Keywords: Transition, EHR, Ambulatory, Prescribing Safety.

Publication types

  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cross-Sectional Studies
  • Drug Therapy, Computer-Assisted*
  • Drug-Related Side Effects and Adverse Reactions / epidemiology
  • Drug-Related Side Effects and Adverse Reactions / prevention & control
  • Electronic Health Records*
  • Electronic Prescribing*
  • Follow-Up Studies
  • Humans
  • Medical Audit
  • Medication Errors / classification
  • Medication Errors / prevention & control*
  • Pharmaceutical Preparations / classification


  • Pharmaceutical Preparations

Associated data

  • ClinicalTrials.gov/NCT00603070