Download PDF
Appl Clin Inform 2025; 16(02): 472-476
DOI: 10.1055/a-2518-0194
Case Report

Ambulatory Medication Change Workflows' Effect on Communication to Pharmacies

Samantha I. Pitts
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Bridgette Thomas
2   Johns Hopkins Care at Home, Johns Hopkins Medicine, Baltimore, Maryland, United States
,
Yushi Yang
3   Johns Hopkins Armstrong Institute, Johns Hopkins Medicine, Baltimore, Maryland, United States
,
Allen R. Chen
4   Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
› Author Affiliations Funding This work received funding from the U.S. Department of Health and Human Services, U.S. Public Health Service, and the Agency for Healthcare Research and Quality R21 HS026584.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background When implemented in both electronic health records (EHRs) and pharmacy management software, CancelRx communicates medication discontinuation in the EHR to pharmacies, which has been demonstrated to reduce medication discrepancies at pharmacies and the risk of medication dispensing after e-prescription discontinuation. Provider workflows for making medication changes and the configuration of CancelRx will affect whether a medication change (e.g., dose adjustment) is communicated to a pharmacy.

Objective This study aimed to assess the effect of CancelRx configuration and the EHR tools used in provider workflows for medication changes on notification to health system and external community pharmacies.

Methods We conducted a functionality analysis of prescriber workflows for documenting a medication change using “change,” “reorder,” “adjust sig,” “discontinue,” and “taking differently.” In the EHR test environment, we examined three outcomes of interest: communication of discontinuation of the old prescription (or cancellation); generation of a new prescription; and instructions to the patient.

Results “Change” was the only single-step function that communicated medication discontinuation to both health system and external community pharmacies with default settings, although “discontinue” followed by a new prescription had the same results. “Reorder” and “adjust sig” functions had different cancellation outcomes for internal and external community pharmacies. “Adjust sig” also had different prescribing outcomes for internal and external pharmacies and “taking differently” did not result in communication of discontinuation or a new prescription at either pharmacy type.

Conclusion Several workflows for dose changes did not communicate to external community pharmacies, resulting in different prescriptions at the health system and external community pharmacies. Health systems leaders should consider the implications of local EHR workflows and CancelRx configuration on communication of medication changes to pharmacies as part of CancelRx implementation. Multidisciplinary collaboration is needed to develop more effective strategies for communication of medication dose changes.

Keywords

electronic prescribing - patient safety - electronic health records - community pharmacies

Protection of Human and Animal Subjects

Analyses were conducted in a test environment without the participation of human subjects or the use of patient data.




Publication History

Received: 03 May 2024

Accepted: 15 January 2025

Article published online:
21 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Sarkar U, López A, Maselli JH, Gonzales R. Adverse drug events in U.S. adult ambulatory medical care. Health Serv Res 2011; 46 (05) 1517-1533
    Search in Google Scholar
  • 2 Net PS. [internet]. Medication Errors and Adverse Drug Events. Rockville, MD: Agency for Healthcare Research and Quality, US Department of Health and Human Services; 2019
    Search in Google Scholar
  • 3 Pitts SI, Olson S, Yanek LR, Wang NY, Woodroof T, Chen AR. Pharmacy e-prescription dispensing before and after CancelRx implementation. JAMA Intern Med 2023; 183 (10) 1120-1126
    Search in Google Scholar
  • 4 Allen AS, Sequist TD. Pharmacy dispensing of electronically discontinued medications. Ann Intern Med 2012; 157 (10) 700-705
    Search in Google Scholar
  • 5 Baranowski PJ, Peterson KL, Statz-Paynter JL, Zorek JA. Incidence and cost of medications dispensed despite electronic medical record discontinuation. J Am Pharm Assoc (Wash DC) 2015; 55 (03) 313-319
    Search in Google Scholar
  • 6 Copi EJ, Kelley LR, Fisher KK. Evaluation of the frequency of dispensing electronically discontinued medications and associated outcomes. J Am Pharm Assoc (Wash DC) 2018; 58 (4S): S46-S50
    Search in Google Scholar
  • 7 Lourenco LM, Bursua A, Groo VL. Automatic errors: a case series on the errors inherent in electronic prescribing. J Gen Intern Med 2016; 31 (07) 808-811
    Search in Google Scholar
  • 8 Watterson TL, Stone JA, Brown R. et al. CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting. J Am Med Inform Assoc 2021; 28 (07) 1526-1533
    Search in Google Scholar
  • 9 Pitts SI, Yang Y, Thomas B, Chen AR. Discontinuation of outpatient medications: implications for electronic messaging to pharmacies using CancelRx. J Am Med Inform Assoc 2022; 29 (12) 2101-2104
    Search in Google Scholar
  • 10 Pitts SI, Barasch N, Maslen AT. et al. Understanding CancelRx: results of end-to-end functional testing, proactive risk assessment, and pilot implementation. Appl Clin Inform 2019; 10 (02) 336-347
    Search in Google Scholar
  • 11 Epic Systems Corporation. Our story in a nutshell. Epic. 2025. Accessed January 7, 2025 at: https://www.epic.com/about/
  • 12 Institute for Safe Medication Practices (ISMP). ISMP List of High-Alert Medications in Community/Ambulatory Care Settings. Plymouth Meeting, PA: ISMP; 2021
  • 13 Yang YPS, Chen AR. Barriers in communicating medication changes at hospital discharge: informing CancelRx design requirements. J Patient Saf Risk Manag 2021; 26 (03) 99-103
    Search in Google Scholar
  • 14 Nelson SD, Kumah-Crystal Y. Underuse of electronic health record features: the case for CancelRx. JAMA Intern Med 2021; 181 (10) 1384-1385
    Search in Google Scholar
  • 15 Schiff G, Mirica MM, Dhavle AA, Galanter WL, Lambert B, Wright A. A prescription for enhancing electronic prescribing safety. Health Aff (Millwood) 2018; 37 (11) 1877-1883
    Search in Google Scholar