title: Transitioning between electronic health records: effects on ambulatory prescribing safety.
abstract: BACKGROUND
  Healthcare providers previously using older electronic health records (EHRs) with electronic prescribing (e-prescribing) are transitioning to newer systems to be eligible for federal meaningful use incentives. Little is known about the safety effects of transitioning between systems.
  
  
  OBJECTIVE
  To assess the effect of transitioning between EHR systems on rates and types of prescribing errors, as well as provider perceptions about the effect on prescribing safety.
  
  
  METHODS
  Prospective, case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009. All physicians transitioned from an older EHR with minimal clinical decision support (CDS) for e-prescribing to a newer EHR with more robust CDS.
  
  
  METHODS
  Prescribing errors were identified by standardized prescription and chart review. A novel survey instrument was administered to evaluate provider perceptions about prescribing safety.
  
  
  RESULTS
  We analyzed 1298 prescriptions at baseline, 1331 prescriptions 12 weeks post-implementation, and 1303 prescriptions one year post-implementation. Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions, 95% confidence interval (CI) 23.2-54.8) and lowest one year post-implementation (12.2 per 100 prescriptions, 95% CI 8.6-17.4) (p < 0.001). Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors. However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions, 95% CI 9.5-33.0 versus 8.5 per 100 prescriptions, 95% CI 4.6-15.9) (p <0.001) and no different at baseline than one year (10.2 per 100 prescriptions, 95% CI 6.2-18.6) (p = 0.337). Survey results complemented quantitative findings.
  
  
  CONCLUSIONS
  Results from this case study suggest that transitioning between systems, even to those with more robust CDS, may pose important safety threats. Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits.
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA. err9009@med.cornell.edu
authors.forename: Erika L
authors.initials: EL
authors.lastname: Abramson
authors.forename: Sameer
authors.initials: S
authors.lastname: Malhotra
authors.forename: Karen
authors.initials: K
authors.lastname: Fischer
authors.forename: Alison
authors.initials: A
authors.lastname: Edwards
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Pfoh
authors.forename: S Nena
authors.initials: SN
authors.lastname: Osorio
authors.forename: Adam
authors.initials: A
authors.lastname: Cheriff
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000639:trends*; D020000:Decision Support Systems, Clinical / Q000639:trends*; D057286:Electronic Health Records / Q000639:trends*; D055695:Electronic Prescribing; D005260:Female; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies