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Effect of EHR User Interface Changes on Internal Prescription Discrepancies
01 April 2014
accepted: 20 June 2014
19 December 2017 (online)
Objective: To determine whether specific design interventions (changes in the user interface (UI)) of an electronic health record (EHR) medication module are associated with an increase or decrease in the incidence of contradictions between the structured and narrative components of electronic prescriptions (internal prescription discrepancies).
Materials and Methods: We performed a retrospective analysis of 960,000 randomly selected electronic prescriptions generated in a single EHR between 01/2004 and 12/2011. Internal prescription discrepancies were identified using a validated natural language processing tool with recall of 76% and precision of 84%. A multivariable autoregressive integrated moving average (ARIMA) model was used to evaluate the effect of five UI changes in the EHR medication module on incidence of internal prescription discrepancies.
Results: Over the study period 175,725 (18.4%) prescriptions were found to have internal discrepancies. The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%).
Addition of „as directed“ option to the <Frequency> dropdown decreased prescription discrepancies by 195 / month (p = 0.0004). An non-interruptive alert that reminded providers to ensure that structured and narrative components did not contradict each other decreased prescription discrepancies by 145 / month (p = 0.03). Addition of a „Renew / Sign“ button to the Medication module (a negative control) did not have an effect in prescription discrepancies.
Conclusions: Several UI changes in the electronic medication module were effective in reducing the incidence of internal prescription discrepancies. Further research is needed to identify interventions that can completely eliminate this type of prescription error and their effects on patient outcomes.
Citation: Turchin A, Sawarkar A, Dementieva YA, Breydo E, Ramelson H. Effect of EHR user interface changes on internal prescription discrepancies. Appl Clin Inf 2014; 5: 708–720
- 1 Adler-Milstein J, Salzberg C, Franz C, Orav EJ, Newhouse JP, Bates DW. Effect of electronic health records on health care costs: Longitudinal comparative evidence from community practices. Ann Intern Med 2013; 159: 97-104.
- 2 DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, Kaushal R, Levy DE, Rosenbaum S, Shields AE, Blumenthal D. Electronic health records in ambulatory care--a national survey of physicians. N Engl J Med 2008; 359: 50-60.
- 3 Wang SJ, Middleton B, Prosser LA, Bardon CG, Spurr CD, Carchidi PJ, Kittler AF, Goldszer RC, Fairchild DG, Sussman AJ, Kuperman GJ, Bates DW. A cost-benefit analysis of electronic medical records in primary care. Am J Med 2003; 114: 397-403.
- 4 Ross SE, Moore LA, Earnest MA, Wittevrongel L, Lin C-T. Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: Randomized trial. Journal of medical Internet research. 2004: 6.
- 5 Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, Taylor R. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs 2005; 24: 1103-1117.
- 6 Bates DW, Ebell M, Gotlieb E, Zapp J, Mullins H. A proposal for electronic medical records in us primary care. Journal of the American Medical Informatics Association 2003; 10: 1-10.
- 7 Bauer JC. Arra and hitech. A medical economist’s analysis. J Healthc Inf Manag 2010; 24: 4-5.
- 8 Blumenthal D, Tavenner M. The „meaningful use“ regulation for electronic health records. N Engl J Med 2010; 363: 501-504.
- 9 Blumenthal D. Launching hitech. N Engl J Med 2010; 362: 382-385.
- 10 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. J Am Med Inform Assoc 2004; 11: 104-112.
- 11 Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2006; 13: 547-556.
- 12 Yackel TR, Embi PJ. Unintended errors with ehr-based result management: A case series. J Am Med Inform Assoc 2010; 17: 104-107.
- 13 Embi PJ, Yackel TR, Logan JR, Bowen JL, Cooney TG, Gorman PN. Impacts of computerized physician documentation in a teaching hospital: Perceptions of faculty and resident physicians. Journal of the American Medical Informatics Association 2004; 11: 300-309.
- 14 Magrabi F, Ong M-S, Runciman W, Coiera E. An analysis of computer-related patient safety incidents to inform the development of a classification. Journal of the American Medical Informatics Association 2010; 17: 663-670.
- 15 Sittig DF, Singh H. Electronic health records and national patient-safety goals. New England Journal of Medicine 2012; 367: 1854-1860.
- 16 Palchuk MB, Fang EA, Cygielnik JM, Labreche M, Shubina M, Ramelson HZ, Hamann C, Broverman C, Einbinder JS, Turchin A. An unintended consequence of electronic prescriptions: Prevalence and impact of internal discrepancies. J Am Med Inform Assoc 2010; 17: 472-476.
- 17 Singh H, Mani S, Espadas D, Petersen N, Franklin V, Petersen LA. Prescription errors and outcomes related to inconsistent information transmitted through computerized order entry: A prospective study. Arch Intern Med 2009; 169: 982-989.
- 18 Marcotte L, Seidman J, Trudel K, Berwick DM, Blumenthal D, Mostashari F, Jain SH. Achieving meaningful use of health information technology: A guide for physicians to the ehr incentive programs. Archives of internal medicine 2012; 172: 731-736.
- 19 Shah NR, Seger AC, Seger DL, Fiskio JM, Kuperman GJ, Blumenfeld B, Recklet EG, Bates DW, Gandhi TK. Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc 2006; 13: 5-11.
- 20 Galitz WO: The essential guide to user interface design: An introduction to gui design principles and techniques. John Wiley & Sons; 2007
- 21 Chertow GM, Lee J, Kuperman GJ, Burdick E, Horsky J, Seger DL, Lee R, Mekala A, Song J, Komaroff AL, Bates DW. Guided medication dosing for inpatients with renal insufficiency. Jama 2001; 286: 2839-2844.
- 22 Peterson JF, Kuperman GJ, Shek C, Patel M, Avorn J, Bates DW. Guided prescription of psychotropic medications for geriatric inpatients. Arch Intern Med 2005; 165: 802-807.
- 23 Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L, Spurr C, Khorasani R, Tanasijevic M, Middleton B. Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003; 10: 523-523.
- 24 Skentzos S, Shubina M, Plutzky J, Turchin A. Structured vs. Unstructured: Factors affecting adverse drug reaction documentation in an emr repository. Proc AMIA Symp 2011: 1270–1279.
- 25 Schedlbauer A, Prasad V, Mulvaney C, Phansalkar S, Stanton W, Bates DW, Avery AJ. What evidence supports the use of computerized alerts and prompts to improve clinicians’ prescribing behavior?. J Am Med Inform Assoc 2009; 16: 531-538.
- 26 Seidling HM, Phansalkar S, Seger DL, Paterno MD, Shaykevich S, Haefeli WE, Bates DW. Factors influencing alert acceptance: A novel approach for predicting the success of clinical decision support. J Am Med Inform Assoc 2011; 18: 479-484.
- 27 Palchuk MB, Turchin A, Alexeyev A, Galperin I, Hamann C. Reducing unintended consequences of e-prescribing on the path to nuanced prescriptions. AMIA Annu Symp Proc 2008: 1079.
- 28 Brennan N, Mattick K. A systematic review of educational interventions to change behaviour of prescribers in hospital settings, with a particular emphasis on new prescribers. British Journal of Clinical Pharmacology 2013; 75: 359-372.
- 29 Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev 2011: 7.
- 30 Times LT. Usability of electronic medical records. Journal of usability studies 2009; 4: 70-84.
- 31 Horsky J, Kuperman GJ, Patel VL. Comprehensive analysis of a medication dosing error related to cpoe. Journal of the American Medical Informatics Association 2005; 12: 377-382.
- 32 Albert W, Tullis T. Measuring the user experience: Collecting, analyzing, and presenting usability metrics. Newnes; 2013
- 33 Turchin A, Shubina M, Goldberg S. Unexpected effects of unintended consequences: Emr prescription discrepancies and hemorrhage in patients on warfarin. AMIA Annu Symp Proc. 2011 2011 1412-1412.