Impact of Electronic Health Record Interface Design on Unsafe Prescribing of Ciclosporin, Tacrolimus, and Diltiazem: Cohort Study in English National Health Service Primary Care

Autor: Richard Croker, Seb Bacon, Brian MacKenna, Ben Goldacre, Helen J Curtis, Alex J Walker
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
020205 medical informatics
Health Informatics
Inappropriate Prescribing
02 engineering and technology
Primary care
lcsh:Computer applications to medicine. Medical informatics
Tacrolimus
ciclosporin
Cohort Studies
primary care
clinical software
Electronic health record
health services administration
0202 electrical engineering
electronic engineering
information engineering
Medicine
Humans
Medical prescription
health care economics and organizations
Retrospective Studies
Original Paper
branded prescribing
Primary Health Care
business.industry
lcsh:Public aspects of medicine
diltiazem
prescribing
Retrospective cohort study
lcsh:RA1-1270
National health service
medicine.disease
Ciclosporin
electronic health records
England
Cyclosporine
lcsh:R858-859.7
Female
Medical emergency
business
Cohort study
medicine.drug
Zdroj: Journal of Medical Internet Research
Journal of Medical Internet Research, Vol 22, Iss 10, p e17003 (2020)
ISSN: 1438-8871
1439-4456
Popis: Background In England, national safety guidance recommends that ciclosporin, tacrolimus, and diltiazem are prescribed by brand name due to their narrow therapeutic windows and, in the case of tacrolimus, to reduce the chance of organ transplantation rejection. Various small studies have shown that changes to electronic health record (EHR) system interfaces can affect prescribing choices. Objective Our objectives were to assess variation by EHR systems in breach of safety guidance around prescribing of ciclosporin, tacrolimus, and diltiazem, and to conduct user-interface research into the causes of such breaches. Methods We carried out a retrospective cohort study using prescribing data in English primary care. Participants were English general practices and their respective EHR systems. The main outcome measures were (1) the variation in ratio of safety breaches to adherent prescribing in all practices and (2) the description of observations of EHR system usage. Results A total of 2,575,411 prescriptions were issued in 2018 for ciclosporin, tacrolimus, and diltiazem (over 60 mg); of these, 316,119 prescriptions breached NHS guidance (12.27%). Breaches were most common among users of the EMIS EHR system (breaches in 18.81% of ciclosporin and tacrolimus prescriptions and in 17.99% of diltiazem prescriptions), but breaches were observed in all EHR systems. Conclusions Design choices in EHR systems strongly influence safe prescribing of ciclosporin, tacrolimus, and diltiazem, and breaches are prevalent in general practices in England. We recommend that all EHR vendors review their systems to increase safe prescribing of these medicines in line with national guidance. Almost all clinical practice is now mediated through an EHR system; further quantitative research into the effect of EHR system design on clinical practice is long overdue.
Databáze: OpenAIRE
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