title: Evaluation of a user guidance reminder to improve the quality of electronic prescription messages.
abstract: BACKGROUND
  Prescribers' inappropriate use of the free-text Notes field in new electronic prescriptions can create confusion and workflow disruptions at receiving pharmacies that often necessitates contact with prescribers for clarification. The inclusion of inappropriate patient direction (Sig) information in the Notes field is particularly problematic.
  
  
  OBJECTIVE
  We evaluated the effect of a targeted watermark, an embedded overlay, reminder statement in the Notes field of an EHR-based e-prescribing application on the incidence of inappropriate patient directions (Sig) in the Notes field.
  
  
  METHODS
  E-prescriptions issued by the same exact cohort of 97 prescribers were collected over three time periods: baseline, three months after implementation of the reminder, and 15 months post implementation. Three certified and experienced pharmacy technicians independently reviewed all e-prescriptions for inappropriate Sig-related information in the Notes field. A physician reviewer served as the final adjudicator for e-prescriptions where the three reviewers could not reach a consensus. ANOVA and post hoc Tukey HSD tests were performed on group comparisons where statistical significance was evaluated at p<0.05.
  
  
  RESULTS
  The incidence of inappropriate Sig-related information in the Notes field decreased from a baseline of 2.8% to 1.8% three months post-implementation and remained stable after 15 months. In addition, prescribers' use of the Notes decreased by 22% after 3 months and had stabilized at 18.7% below baseline after 15 months.
  
  
  CONCLUSIONS
  Insertion of a targeted watermark reminder statement in the Notes field of an e-prescribing application significantly reduced the incidence of inappropriate Sig-related information in Notes and decreased prescribers' use of this field.
authors.affiliation: Surescripts LLC , Arlington, VA, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Dhavle
authors.affiliation: NextGen Healthcare Information Systems LLC , Horsham, PA, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Corley
authors.affiliation: Midwestern University , Glendale, AZ, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Rupp
authors.affiliation: Surescripts LLC , Arlington, VA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Surescripts LLC , Arlington, VA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.affiliation: NextGen Healthcare Information Systems LLC , Horsham, PA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Gill
authors.affiliation: Surescripts LLC , Arlington, VA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Sow
mesh_terms: D004282:Documentation / Q000592:standards*; D055695:Electronic Prescribing / Q000592:standards*; D016247:Information Storage and Retrieval / Q000592:standards; D008508:Medication Errors / Q000517:prevention & control*; D011785:Quality Assurance, Health Care / Q000592:standards*; D017010:Reminder Systems / Q000592:standards*; D060145:Text Messaging / Q000592:standards*; D014481:United States; D014584:User-Computer Interface
keywords: Electronic prescribing; computerized physician order entry system; electronic transmission of prescriptions; errors; quality improvement