18 Dec Not All Electronic Health Record Warnings Are Accurate

MedicalResearch.com Interview with:

Dr. Phillips

Katharine Phillips, M.D.
Professor of Psychiatry
DeWitt Wallace Senior Scholar
Residency Research Director
Department of Psychiatry
Weill Cornell Medical College, Cornell University
Attending Psychiatrist, New York-Presbyterian Hospital
Adjunct Professor of Psychiatry and Human Behavior
Alpert Medical School of Brown University
Weill Cornell Psychiatry Specialty Center
Weill Cornell Medicine I NewYork-Presbyterian

MedicalResearch.com: What is the background for this study? What are the main findings?

• Electronic prescribing of medication by clinicians is widespread; it is required in many institutions and in some states. Electronic prescribing systems commonly use computerized decision support algorithms that give prescribers automated warnings or alerts at the time of prescribing if the system identifies a potential prescribing error.
• Some prior studies suggest that electronic prescribing warnings/alerts may reduce prescribing errors and thus can be clinically useful. However, other prior studies caution that these alerts may have substantial limitations.
• Despite the importance of this topic, relatively few studies have examined the accuracy of automated prescribing warnings in electronic prescribing systems; to our knowledge, no prior study has focused primarily on prescribing of medications for psychiatric conditions.
• This report presents results from a survey of members of the American Society of Clinical Psychopharmacology (ASCP), a specialty society that advances the science and practice of clinical psychopharmacology, regarding automated warnings generated by electronic prescribing systems.

MedicalResearch.com: What are the main findings?

• 118 ASCP members from 33 states completed the survey (9.6% response rate). Overall, survey respondents used a total of 31 different electronic prescribing systems.
• Among those respondents who electronically prescribe, 83% reported that their electronic prescribing system provides automated warnings at the time of prescribing if the system detects a potentially problematic prescription. Among these individuals, one-third believed that their system has provided incorrect warning information, and one-third of this latter group believed that warnings were inaccurate 50% or more of the time.
• Types of information in prescribing alerts that clinicians considered inaccurate were dosing range (reported by 54% of respondents), drug interactions (50%), contraindications (situations in which the medication should never be prescribed) (42%), dosing frequency (38%), dosing time (13%), indications (reasons for prescribing the medication) (13%), and other (9%).
• Some warnings/alerts did not reflect official medication labeling information that is approved by the Food and Drug Administration (FDA) for prescription medications.
• A majority of respondents reported being unable to alert their electronic prescribing system when prescribing warnings were incorrect.

MedicalResearch.com: What should readers take away from your report?

• A substantial proportion of prescribing clinicians with an interest in psychopharmacology believe that their electronic prescribing system has provided incorrect prescribing warnings. Clinicians should be aware that some electronic prescribing warnings/alerts may be inaccurate.
• It is especially puzzling and problematic that some warnings do not reflect official FDA-approved information about medications (product labeling information) —for example, information pertaining to maximum medication dose or contraindications.
• Such errors potentially have profound consequences. For example, the erroneous warning that serotonin reuptake inhibitor (SRI) medications and aripiprazole are contraindicated (that is, should never be used) for children and adolescents may cause inadequate treatment of potentially life-threatening conditions in this age group, such as major depressive disorder. Presently, serotonin reuptake inhibitors and aripiprazole are approved by the FDA for multiple conditions in youth.
• Erroneous alerts may be especially problematic when encountered by prescribers who do not have expertise in prescribing psychiatric medication and thus may not recognize their inaccuracy.
• Clinicians also need to be aware that not all warnings are inaccurate, and thus they should carefully review each alert and not automatically override or ignore alerts without review, because accurate alerts are potentially very useful clinically. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

• Additional, larger surveys of this type are needed to confirm and extend our findings, especially given increasing use of electronic prescribing and the potentially detrimental clinical consequences of inaccurate prescribing warnings.
• Future studies should address some of the limitations of this study, such as a low survey response rate, lack of confirmation regarding whether warnings/alerts that clinicians perceived to be inaccurate actually were inaccurate, perceived usefulness of warnings/alerts, and which electronic prescribing systems specifically contain errors such as those reported in this survey (we cannot conclude on the basis of our survey that all or most electronic systems used by survey respondents contain such errors). 

Any disclosures?
Here are my disclosures for the past 12 months; I do not think that any are relevant to this interview/article.

• Oxford University Press (book royalties)
• International Creative Management, Inc. (book royalties)
• UpToDate (royalties)
• Guilford Press (book royalties)
• Merck Manual (honorarium) 

Citation:

Inaccurate Prescribing Warnings in Electronic Medical Record Systems: Results From an American Society of Clinical Psychopharmacology Membership Survey

The American Society of Clinical Psychopharmacology (ASCP) Abstract December 2018

https://pmg.joynadmin.org/documents/1005/5c102f4e68ed3f222f376c42.pdf

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Last Updated on December 18, 2018 by Marie Benz MD FAAD