Implementation outcomes of the Structured and Codified SIG format in electronic prescription directions

J Am Med Inform Assoc. 2022 Oct 7;29(11):1859-1869. doi: 10.1093/jamia/ocac124.


Objective: To determine the extent of implementation, completeness, and accuracy of Structured and Codified SIG (S&C SIG) directions on electronic prescriptions (e-prescriptions).

Materials and methods: A retrospective analysis of a random sample of 3.8 million e-prescriptions sent from electronic prescribing (e-prescribing) software to outpatient pharmacies in the United States between 2019 and 2021. Natural language processing was used to identify direction components, including action verb, dose, frequency, route, duration, and indication from free-text directions and were compared to the S&C SIG format. Inductive qualitative analysis of S&C direction identified error types and frequencies for each component.

Results: Implementation of the S&C SIG format in e-prescribing software resulted in 32.4% of e-prescriptions transmitted with these standardized directions. Directions using the S&C SIG format contained a greater percentage of each direction component compared to free-text directions, except for the indication component. Structured and codified directions contained quality issues in 10.3% of cases.

Discussion: Expanding adoption of more diverse direction terminology for the S&C SIG formats can improve the coverage of directions using the S&C SIG format. Building out e-prescribing software interfaces to include more direction components can improve patient medication use and safety. Quality improvement efforts, such as improving the design of e-prescribing software and auditing for discrepancies, are needed to identify and eliminate implementation-related issues with direction information from the S&C SIG format so that e-prescription directions are always accurately represented.

Conclusion: Although directions using the S&C SIG format may result in more complete directions, greater adoption of the format and best practices for preventing its incorrect use are necessary.

Keywords: Structured and Codified SIG; computerized provider order entry; electronic prescriptions; medication directions; patient safety.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Drug Prescriptions
  • Electronic Prescribing*
  • Humans
  • Medication Errors / prevention & control
  • Natural Language Processing
  • Pharmacies*
  • Retrospective Studies
  • United States

Grant support