title: Impact of Early Electronic Prescribing on Pharmacists' Clarification Calls in Four Community Pharmacies Located in St John's, Newfoundland.
abstract: BACKGROUND
  Electronic prescribing (e-prescribing) can potentially help prevent medication errors. As the use of e-prescribing increases across Canada, understanding the benefits and gaps of early e-prescribing can help inform deployment of future e-prescribing systems.
  
  
  OBJECTIVE
  The purpose of this exploratory study was to determine the prevalence of, reasons for, and average time taken for pharmacist clarification calls to prescribers for electronic medical record (EMR)-generated and handwritten prescriptions.
  
  
  METHODS
  Four community pharmacies in St John's, Newfoundland, Canada prospectively collected information on clarification calls to prescribers for new prescriptions over a period of 17 to 19 weeks. Four semistructured interviews were conducted following the data collection period to gain further insight.
  
  
  RESULTS
  An estimated 1.33% of handwritten prescriptions required clarification compared with 0.66% of EMR-generated prescriptions. Overall, 1.11% of prescriptions required clarification with the prescriber. While illegibility was eliminated with EMR-generated prescriptions, clarification was still required for missing information (24%) and appropriateness (51%). Key themes, including errors unique to EMR-generated prescriptions, emerged from the qualitative interviews.
  
  
  CONCLUSIONS
  Advanced e-prescribing functionality will enable secure transmission of prescriptions from prescribers to a patient's pharmacy of choice through a provincial electronic Drug Information System (DIS)/Pharmacy Network, which will lessen the need for clarification calls, especially in the domains of missing information and appropriateness of the prescription. This exploratory study provides valuable insight into the benefits and gaps of early e-prescribing. Advanced e-prescribing systems will provide an opportunity for further realization of quality and safety benefits related to medication prescribing.
authors.affiliation: NL Centre for Health Information, Research and Evaluation, St John's, NL, Canada. jennifer.phillips@nlchi.nl.ca.
authors.forename: Jennifer L
authors.identifier: http://orcid.org/0000-0002-1765-9528
authors.initials: JL
authors.lastname: Phillips
authors.forename: Jennifer M
authors.identifier: http://orcid.org/0000-0002-3791-6819
authors.initials: JM
authors.lastname: Shea
authors.forename: Valerie
authors.identifier: http://orcid.org/0000-0002-6780-5378
authors.initials: V
authors.lastname: Leung
authors.forename: Don
authors.identifier: http://orcid.org/0000-0002-2332-2016
authors.initials: D
authors.lastname: MacDonald
keywords: Clinical Pharmacy Information Systems; electronic prescribing; pharmacists; pharmacy