title: The effects of electronic prescribing by community-based providers on ambulatory medication safety.
abstract: BACKGROUND
  US federal policies are incentivizing use of electronic prescribing (e-prescribing) to improve safety. However, little is known about e-prescribing's actual impact on medication safety over time. A study was conducted to assess the effect of implementing a commercial electronic health record (EHR) with e-prescribing on rates and types of prescribing errors. Understanding safety effects from e-prescribing will be important as providers increasingly e-prescribe.
  
  
  METHODS
  Prescriptions written by 20 community-based primary care providers in the Hudson Valley region of New York from November 2008 to November 2009 were retrospectively studied. All providers adopted a commercial EHR with robust clinical decision support and extensive technical support to aid in prescribing. Errors were identified by standardized prescription and chart review.
  
  
  RESULTS
  Some 1,629 prescriptions were analyzed at three months postimplementation, and 1,738 prescriptions were analyzed at one year postimplementation. Use of e-prescribing resulted in relatively low error rates (6.0 errors per 100 prescriptions). These rates were sustained over time but without further improvement (6.0 versus 4.5 errors per 100 prescriptions, p = .15). Antibiotics were the class of medications most frequently involved (12.7% of overall errors), and direction errors were most common (24% of errors).
  
  
  CONCLUSIONS
  This study is the first, as far as known, to quantitatively evaluate prescribing errors early after EHR implementation and after sustained use among community-based primary care providers. Relatively low rates of errors with e-prescribing were found early and after prolonged use. Extensive support for providers before, during, and after implementation may mitigate potential safety threats from implementation of an EHR system and result in sustained safety benefits over the long-term.
authors.affiliation: Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York City, NY, USA. err9009@med.cornell.edu
authors.forename: Erika L
authors.initials: EL
authors.lastname: Abramson
authors.affiliation: Divison of Quality and Medical Informatics, Weill Cornell Medical College, New York City, NY, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Pfoh
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York City, NY, USA.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barrón
authors.affiliation: Taconic Independent Practice Association, Fishkill, New York, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Quaresimo
authors.affiliation: Komansky Center for Children's Health, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D055695:Electronic Prescribing / Q000592:standards*; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D009518:New York; D061214:Patient Safety; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States