Inappropriate use of 'notes' field in e-prescribing can cause patient harm

Tools

Doctors' use of the free-text "notes" field in e-prescriptions to communicate additional prescription-related information to pharmacists can create confusion and even patient harm, according to research published in JAMA Internal Medicine.

The researchers evaluated 28,002 e-prescriptions transmitted over the Surescripts network in November 2013. The researchers found 14.9 percent included information in the notes field, with 66.1 percent of that data seen as inappropriate content for which an available standard, structured data-entry field should have been used.

The researchers deemed 19 percent of the field's content, including inappropriate content, a potential safety concern since it may conflict with information in the "directions" field.

Vague, ambiguous, or conflicting patient directions in the notes field can hamper pharmacy workflow and result in dispensing errors if unnoticed, ignored or misinterpreted by pharmacy staff, the researchers say.

Many instances of inappropriate use of the notes field result from delayed adoption in the e-prescribing industry of the newer versions of the SCRIPT standard which contain more structured fields. Of particular concern, according to the authors, is use of the notes field to discontinue medication therapy rather than a cancel prescription request/response messages available in SCRIPT, version 10.6.

They say their research highlights the need for better prerelease usability testing, consistent end-user training and feedback, and rigorous postmarket evaluation and surveillance of electronic health record or e-prescribing software applications.

Sixty-seven percent of all new prescriptions were processed through the Surescripts network in 2014.

Giving pharmacists access to the patient's EHR can improve physician-pharmacy communication and workflow, according to research published in the American Health Information Management Association's Perspectives in Health Information Management.

To learn more:
- read the abstract

Related Articles:
Surescripts activates National Record Locator Service
Electronic pharmacy claims data helps prevent med errors
Shared EHR access between docs, pharmacists can improve communication, workflow
Surescripts: Health data transactions outnumber American Express, PayPal