title: Effects of an e-Prescribing interface redesign on rates of generic drug prescribing: exploiting default options.
abstract: Increasing the use of generic medications could help control medical costs. However, educational interventions have limited impact on prescriber behavior, and e-prescribing alerts are associated with high override rates and alert fatigue. Our objective was to evaluate the effect of a less intrusive intervention, a redesign of an e-prescribing interface that provides default options intended to "nudge" prescribers towards prescribing generic drugs.
  
  
  
  This retrospective cohort study in an academic ambulatory multispecialty practice assessed the effects of customizing an e-prescribing interface to substitute generic equivalents for brand-name medications during order entry and allow a one-click override to order the brand-name medication.
  
  
  
  Among drugs with generic equivalents, the proportion of generic drugs prescribed more than doubled after the interface redesign, rising abruptly from 39.7% to 95.9% (a 56.2% increase; 95% confidence interval, 56.0-56.4%; P < .001). Before the redesign, generic drug prescribing rates varied by therapeutic class, with rates as low as 8.6% for genitourinary products and 15.7% for neuromuscular drugs. After the redesign, generic drug prescribing rates for all but four therapeutic classes were above 90%: endocrine drugs, neuromuscular drugs, nutritional products, and miscellaneous products.
  
  
  
  Changing the default option in an e-prescribing interface in an ambulatory care setting was followed by large and sustained increases in the proportion of generic drugs prescribed at the practice.
  
  
  
  Default options in health information technology exert a powerful effect on user behavior, an effect that can be leveraged to optimize decision making.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Physician Organization, Weill Cornell Medical College, New York, NY, USA sam2032@med.cornell.edu.
authors.forename: Sameer
authors.initials: S
authors.lastname: Malhotra
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Physician Organization, Weill Cornell Medical College, New York, NY, USA Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Cheriff
authors.affiliation: Physician Organization, Weill Cornell Medical College, New York, NY, USA Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: J Travis
authors.initials: JT
authors.lastname: Gossey
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Physician Organization, Weill Cornell Medical College, New York, NY, USA Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Cole
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Department of Medicine, Weill Cornell Medical College, New York, NY, USA Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Ancker
mesh_terms: D000553:Ambulatory Care; D057915:Drug Substitution / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D016568:Drugs, Generic / Q000627:therapeutic use*; D055695:Electronic Prescribing; D006801:Humans; D050316:Medical Order Entry Systems; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014584:User-Computer Interface
chemical_list: D016568:Drugs, Generic
keywords: Drug substitution; electronic health records; electronic prescribing; generic drugs; human-computer interaction; order entry systems