E-Prescribing Pivotal to Reducing Drug Errors

A new Institute of Medicine report recommends broader adoption of electronic prescribing and other measures to cut down on the number of patients who get the wrong drug, dosage or mix of medications.

Medication errors are occurring at the alarming rate of an estimate of at least 1.5 million preventable adverse drug events each year. In addition, there frequently is a lack of coordination and communication between physicians, pharmacists and patients about what medications are being taken, according to members of the IOM Committee on Identifying and Preventing Medication Errors, who presented the report’s findings at a recent press briefing here.

“I am a patient-safety researcher, and, as we went through the process over the past two years of putting this report together, I was surprised and shocked at just how common and serious a problem this is. I think we all need to wake up and take this more seriously,” Albert Wu, M.D., professor of health policy and management and internal medicine at Johns Hopkins School of Medicine, Baltimore, said at the briefing.

Research cited in the IOM report projects the number of medication errors in hospitals to be approximately 380,000 annually. Research also projects that there are approximately 800,000 errors in long-term care facilities annually, and 530,000 preventable adverse drug events among Medicare’s ambulatory population each year.

Those numbers don’t include community data or errors of omission, such as the well-documented incidence of inadequate treatment for serious conditions, including acute coronary syndrome, heart failure, chronic coronary disease and atrial fibrillation, according to the report.

“The current process by which medications are prescribed, dispensed, administered and monitored is characterized by many serious problems that threaten both the safety and the positive outcomes we hope to achieve when we serve patients,” said J. Lyle Bootman, Ph.D., Sc.D., co-chair of the IOM committee and a pharmacy professor and researcher at the University of Arizona, Tucson, at the briefing.

The report calls for physicians and patients to establish and maintain a strong partnership to reduce medical errors. “Consumers should maintain careful records of their medications, providers should review a patient’s list of medications at each encounter and at times of transition between care settings (for example, hospital to outpatient care),” the report states.

The panel provided several other recommendations for improving the current system. Health information technology in general, and electronic prescribing specifically, appeared near the top of that list.

“Studies indicate that paper-based prescribing is associated with very high error rates, but electronic prescribing is safer because it eliminates problems with handwriting illegibility and, when combined with decision support tools, automatically alerts prescribers to possible interactions, allergies and other potential problems,” said Bootman.

Based on their findings, the committee members recommended that all physicians have plans in place to implement electronic prescribing by 2008 and that those systems should be in place and integrated by 2010.

Those goals are achievable, said David C. Kibbe, M.D., the director of AAFP’s Center for Health Information Technology.

Currently a little less than one-third of family physicians have adopted electronic health records, but more practices are realizing that a good EHR system can improve the efficiency of their practice and be cost effective. Electronic prescribing especially is a huge time- and money saver, Kibbe said in an interview.

According to the Academy’s own data, the interest in electronic health records is skyrocketing among small physician offices, IOM committee member Wilson Pace, M.D., a professor of family medicine at the University of Colorado, Denver, and director of AAFP’s National Research Network, said at the briefing.

The AAFP 2005 EHR Survey (PDF file: 11 pages / 483 KB. More about PDFs.) found that the adoption of EHR systems among respondents had nearly doubled since the 2003 survey. Respondents listed e-prescribing and managing medication lists among the top five benefits of electronic health record systems.

“Being a physician, I think that e-prescribing is one of the keystones of (the effort to reduce medical errors). It allows us to apply decision support, it allows us to transmit the information, it allows us to capture medications. It is the key to getting the data you need in an electronic format so that you can apply all the others systems to it,” said Pace.

Electronic records and other systems have become more affordable during the past couple of years. Specifically, Internet-based options allow physicians to prescribe electronically literally for pennies, he added. “The perception out there is that everybody has to use systems that are $2,000 or more per person, but there are other options available today,” said Pace. He also noted that physicians should consider electronic prescribing as important as X-ray machines or any other vital clinical tool.

The IOM panel also called for the federal government to play a larger role in pulling together regional and national efforts to study medical errors and build on recent research findings.

“This complements our CMS Quality Roadmap strategies,” said Barry Straube, M.D., acting director of the Office of Clinical Standards and Quality and acting chief medical officer at CMS, which funded the IOM report.

The CMS strategy comprises five components:

Members of the panel also called for the government to increase funding for these initiatives.

“If harm from medication errors was a single disease, we would be investing more heavily. Research funding from the government for cancer numbers in the billions every year, yet the proportion of people who are affected by medication errors is far greater than people with cancer,” said Wu.