title: How many medication orders are entered through free-text in EHRs?--a study on hypoglycemic agents.
abstract: Computerized Provider Order Entry (CPOE) can reduce medication errors; however, its benefits are only achieved when data are entered in a structured format and entries are properly coded. This paper aims to explore the incidence of free-text medication order entries involving hypoglycemic agents in an ambulatory electronic health record (EHR) system with CPOE. Our results showed that free-text order entry continues to be frequent. During 2010, 9.3% of hypoglycemic agents were entered as free-text for 2,091 patients. 17.4% of the entries contained misspellings. The highest proportion of free-text entries were found in urgent care clinics (49.4%) and among registered nurses (31.5%). Additionally, 92 drug-drug interaction alerts were not triggered due to free-text entries. Only 25.9% of the patients had diabetes recorded in their problem list. Solutions will require policy to enforce structured entry, ongoing improvement in user-interface design, improved training for users, and strategies for maintaining a complete medication list.
authors.affiliation: Clinical Informatics Research & Development, Partners HealthCare System, Boston, MA, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Mahoney
authors.forename: Anastasiya
authors.initials: A
authors.lastname: Shakurova
authors.forename: Foster
authors.initials: F
authors.lastname: Goss
authors.forename: Frank Y
authors.initials: FY
authors.lastname: Chang
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Roberto A
authors.initials: RA
authors.lastname: Rocha
mesh_terms: D020000:Decision Support Systems, Clinical; D019033:Delivery of Health Care, Integrated; D004360:Drug Therapy, Computer-Assisted; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D050316:Medical Order Entry Systems; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control; D008510:Medication Systems, Hospital
chemical_list: D007004:Hypoglycemic Agents