title: Electronic prescribing improves medication safety in community-based office practices.
abstract: BACKGROUND
  Although electronic prescribing (e-prescribing) holds promise for preventing prescription errors in the ambulatory setting, research on its effectiveness is inconclusive.
  
  
  OBJECTIVE
  To assess the impact of a stand-alone e-prescribing system on the rates and types of ambulatory prescribing errors.
  
  
  METHODS
  Prospective, non-randomized study using pre-post design of 15 providers who adopted e-prescribing with concurrent controls of 15 paper-based providers from September 2005 through June 2007.
  
  
  METHODS
  Use of a commercial, stand-alone e-prescribing system with clinical decision support including dosing recommendations and checks for drug-allergy interactions, drug-drug interactions, and duplicate therapies.
  
  
  METHODS
  Prescribing errors were identified by a standardized prescription and chart review.
  
  
  RESULTS
  We analyzed 3684 paper-based prescriptions at baseline and 3848 paper-based and electronic prescriptions at one year of follow-up. For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions (95% confidence interval (CI), 36.7-49.3) at baseline to 6.6 per 100 prescriptions (95% CI, 5.1-8.3) one year after adoption (p < 0.001). For non-adopters, error rates remained high at 37.3 per 100 prescriptions (95% CI, 27.6-50.2) at baseline and 38.4 per 100 prescriptions (95% CI, 27.4-53.9) at one year (p = 0.54). At one year, the error rate for e-prescribing adopters was significantly lower than for non-adopters (p < 0.001). Illegibility errors were very high at baseline and were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year).
  
  
  CONCLUSIONS
  Prescribing errors may occur much more frequently in community-based practices than previously reported. Our preliminary findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety.
  
  
  BACKGROUND
  ClinicalTrials.gov, Taconic Health Information Network and Community (THINC), NCT00225563, http://clinicaltrials.gov/ct2/show/NCT00225563?term=Kaushal&rank=6 .
authors.affiliation: Department of Pediatrics, Weill Medical College of Cornell University, 402 East 67th Street, Room-LA-259, New York, NY 10065, USA. rak2007@med.cornell.edu
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kern
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barrón
authors.forename: Jill
authors.initials: J
authors.lastname: Quaresimo
authors.forename: Erika L
authors.initials: EL
authors.lastname: Abramson
mesh_terms: D000328:Adult; D000368:Aged; D003153:Community Health Services; D011307:Drug Prescriptions; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008875:Middle Aged; D009518:New York; D010824:Physicians' Offices; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012424:Rural Population; D012449:Safety; D017751:Safety Management; D013383:Suburban Population