Sunday, December 23, 2018
Now This Is A Really Disturbing Article That Potentially Undermines Many Of The Benefit Claims Of EHRs.
This appeared last week.
Published December 18 2018, 7:24am EST
Electronic prescribing systems send physicians automated warnings when a potential problem with a prescription is detected. Yet, the accuracy of these decision support algorithms is being questioned.
A new survey of members of the American Society of Clinical Psychopharmacology finds that one-third of those surveyed believe their e-prescribing system has provided erroneous warning information—with one-third of this group indicating that the alerts were inaccurate 50 percent or more of the time.
Specifically, the categories of information in e-prescribing alerts that clinicians considered inaccurate were dosing range (54.2 percent), drug interactions (50 percent), contraindications (41.7 percent), dosing frequency (37.5 percent), dosing time (12.5 percent) and indications (12.5 percent).
Results of the survey, based on responses from 118 ASCP members from 33 states, were published earlier this month in the Journal of Clinical Psychiatry.
“The results of this survey indicate that a substantial proportion of prescribing clinicians with an interest in psychopharmacology believe that their electronic prescribing system has provided incorrect prescribing warnings,” state the study’s authors. “Such errors potentially have profound consequences.”
For example, they point out that that the “erroneous warning that serotonin reuptake inhibitor medications and aripiprazole are contraindicated for children and adolescents may cause inadequate treatment of potentially life-threatening conditions in this age group, such as major depressive disorder.”
The study makes the case that incorrect alerts “may be especially problematic when encountered by prescribers who do not have expertise in prescribing psychotropic medication and thus may not recognize their inaccuracy.”
While most respondents to the survey indicated that they could override erroneous warnings and prescribe the desired medication, a majority of those surveyed said they were unable to alert the system about the inaccuracy of a prescribing warning. In fact, half of respondents reported that requirements to override or otherwise respond to alerts were at least moderately burdensome.
Here is the link:
The worry with all this is that the benefits of electronic prescribing and medication management are inextricably tied to the accuracy of the prescribing data contained in the system and the quality of the potential interaction / side-effect detection.
As most paper based prescribing manuals can be close to 100% correct it is hard to understand just what is going on with the electronic systems. I wonder what an audit of Australian e-prescribing systems would show. It certainly would be worthwhile knowing!!! And fixing as appropriate. Surely was should be able to be 100% confident of the data in the relatively static data systems that support clinical systems and how they process that data?
Posted by Dr David G More MB PhD at Sunday, December 23, 2018