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
› Institutsangaben

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.
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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.

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.




Publikationsverlauf

Eingereicht: 03. Mai 2024

Angenommen: 15. Januar 2025

Artikel online veröffentlicht:
21. Mai 2025

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