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Appl Clin Inform 2023; 14(05): 981-991
DOI: 10.1055/s-0043-1777107
Research Article

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool

Zoe Co
1   Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
2   Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, United States
,
David C. Classen
3   Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States
,
Jessica M. Cole
3   Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States
,
Diane L. Seger
4   Clinical and Quality Analysis, Mass General Brigham, Somerville, Massachusetts, United States
,
Randy Madsen
5   Biomedical Informatics Core, Clinical and Translational Science Institute, University of Utah, Salt Lake City, Utah, United States
,
Terrance Davis
5   Biomedical Informatics Core, Clinical and Translational Science Institute, University of Utah, Salt Lake City, Utah, United States
,
Patricia McGaffigan
6   Institute of Health Improvement, Boston, Massachusetts, United States
,
David W. Bates
1   Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
5   Biomedical Informatics Core, Clinical and Translational Science Institute, University of Utah, Salt Lake City, Utah, United States
7   Harvard Medical School, Boston, Massachusetts, United States
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Abstract

Background The purpose of the Ambulatory Electronic Health Record (EHR) Evaluation Tool is to provide outpatient clinics with an assessment that they can use to measure the ability of the EHR system to detect and prevent common prescriber errors. The tool consists of a medication safety test and a medication reconciliation module.

Objectives The goal of this study was to perform a broad evaluation of outpatient medication-related decision support using the Ambulatory EHR Evaluation Tool.

Methods We performed a cross-sectional study with 10 outpatient clinics using the Ambulatory EHR Evaluation Tool. For the medication safety test, clinics were provided test patients and associated medication test orders to enter in their EHR, where they recorded any advice or information they received. Once finished, clinics received an overall percentage score of unsafe orders detected and individual order category scores. For the medication reconciliation module, clinics were asked to electronically reconcile two medication lists, where modifications were made by adding and removing medications and changing the dosage of select medications.

Results For the medication safety test, the mean overall score was 57%, with the highest score being 70%, and the lowest score being 40%. Clinics performed well in the drug allergy (100%), drug dose daily (85%), and inappropriate medication combinations (74%) order categories. Order categories with the lowest performance were drug laboratory (10%) and drug monitoring (3%). Most clinics (90%) scored a 0% in at least one order category. For the medication reconciliation module, only one clinic (10%) could reconcile medication lists electronically; however, there was no clinical decision support available that checked for drug interactions.

Conclusion We evaluated a sample of ambulatory practices around their medication-related decision support and found that advanced capabilities within these systems have yet to be widely implemented. The tool was practical to use and identified substantial opportunities for improvement in outpatient medication safety.

Keywords

patient safety - ambulatory care - clinical decision support systems

Protection of Human and Animal Subjects

No real patients were used in the testing scenarios in the Ambulatory EHR Evaluation Tool, only test patients were used.




Publikationsverlauf

Eingereicht: 11. Juli 2023

Angenommen: 24. Oktober 2023

Artikel online veröffentlicht:
13. Dezember 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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