CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting

Abstract

Objective: Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic's electronic health record (EHR) to the outpatient pharmacy's software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.

Materials and methods: CancelRx was implemented in October 2017 at an academic health system. For 12 months prior, and 12 months after CancelRx implementation, data were collected on discontinued medications in the health system's EHR and whether those prescriptions were successfully discontinued in the pharmacy's dispensing software. An interrupted time series analysis was conducted to model the occurrence of prescriptions successfully discontinued over time.

Results: There was an immediate (lag = 0), significant (P < 0.001), and sustained (post-implementation slope 0.02) increase in the proportion of successful medication discontinuations after CancelRx implementation (from 34% to 93%). CancelRx had variable impact based on whether the clinic was primary care (71.4% change prepost) or specialty care (53.9% change prepost). CancelRx reduced the time between when a medication was discontinued in the clinic EHR and pharmacy dispensing software.

Conclusion: CancelRx automated a manual process and illustrated the role for health IT in communicating medication discontinuations between clinics and pharmacies. Overall, CancelRx had a marked benefit on medication list discrepancies and illustrated how health IT can be used across different settings to improve patient care.

Keywords: health information technology; implementation science; interrupted time series analysis; patient safety.

Figure 1.

Medication discontinuation process pre- and post-CancelRx.

Figure 2.

Successful medication discontinuations pre- and post-CancelRx implementation. The figure illustrates the proportion of successful medication discontinuations over time—the medications discontinued in both the clinic and pharmacy systems after they were indicated as discontinued in the clinic. The Figure shows that only 34% of medications were successfully continued pre-CancelRx, but after, the proportion increased significantly to over 90%.

Figure 3.

Successful medication discontinuations pre- and post-CancelRx implementation by clinic type. The figure illustrates the proportion of successful medication discontinuations over time—separated by the type of clinic that the discontinuation message came from. The figure illustrates that priori to CancelRx, specialty clinics had a higher proportion of medications successfully discontinued, and after CancelRx, specialty and primary care clinics had about the same proportion.

Figure 4.

Average time to discontinuations pre- and post-CancelRx Implementation. The figure illustrates the average time, in hours, between when a medication is discontinued in the clinic to when it is discontinued in the pharmacy. After CancelRx, there is less variability in the amount of time it takes to communicate medication discontinuations.