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The comparative effectiveness of 2 electronic prescribing systems.

OBJECTIVES
The increasingly widespread adoption of electronic health records (EHRs) is substantially changing the American healthcare delivery system. Differences in the actual effectiveness of EHRs and their component applications, including electronic prescribing (e-prescribing), is not well understood. We compared the effects of 2 types of e-prescribing systems on medication safety as an example of how comparative effectiveness research (CER) can be applied to the study of healthcare delivery.


STUDY DESIGN AND METHODS
We previously conducted 2 non-randomized, prospective studies with pre-post controls comparing prescribing errors among: (1) providers who adopted a standalone e-prescribing system with robust technical and clinical decision support (CDS) and (2) providers who adopted an EHR with integrated e-prescribing with less robust available CDS and technical support. Both studies evaluated small groups of ambulatory care providers in the same New York community using identical methodology including prescription and chart reviews. We undertook this comparative effectiveness study to directly compare prescribing error rates among the 2 groups of e-prescribing adopters.


RESULTS
The stand-alone system reduced error rates from 42.5 to 6.6 errors per 100 prescriptions (P <.001). The integrated system reduced error rates from 26.0 to 16.0 per 100 prescriptions (P= .07). After adjusting for baseline differences, stand-alone users had a 4-fold lower rate of errors at 1 year (P <.001).


CONCLUSIONS
Despite improved work flow integration, the integrated e-prescribing application performed less well, likely due to differences in available CDS and technical resources. Results from this small study highlight the importance of CER that directly compares components of healthcare delivery.