Survey: One-third of clinicians say e-prescribing systems give incorrect warnings

Electronic prescribing systems send physicians automated warnings when a potential problem with a prescription is detected. Yet, the accuracy of these decision support algorithms is being questioned.

A new survey of members of the American Society of Clinical Psychopharmacology finds that one-third of those surveyed believe their e-prescribing system has provided erroneous warning information—with one-third of this group indicating that the alerts were inaccurate 50 percent or more of the time.

Specifically, the categories of information in e-prescribing alerts that clinicians considered inaccurate were dosing range (54.2 percent), drug interactions (50 percent), contraindications (41.7 percent), dosing frequency (37.5 percent), dosing time (12.5 percent) and indications (12.5 percent).

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Results of the survey, based on responses from 118 ASCP members from 33 states, were published earlier this month in the Journal of Clinical Psychiatry.

“The results of this survey indicate that a substantial proportion of prescribing clinicians with an interest in psychopharmacology believe that their electronic prescribing system has provided incorrect prescribing warnings,” state the study’s authors. “Such errors potentially have profound consequences.”

For example, they point out that that the “erroneous warning that serotonin reuptake inhibitor medications and aripiprazole are contraindicated for children and adolescents may cause inadequate treatment of potentially life-threatening conditions in this age group, such as major depressive disorder.”

The study makes the case that incorrect alerts “may be especially problematic when encountered by prescribers who do not have expertise in prescribing psychotropic medication and thus may not recognize their inaccuracy.”

Also See: E-prescribing of controlled substances seen as easy, safe

While most respondents to the survey indicated that they could override erroneous warnings and prescribe the desired medication, a majority of those surveyed said they were unable to alert the system about the inaccuracy of a prescribing warning. In fact, half of respondents reported that requirements to override or otherwise respond to alerts were at least moderately burdensome.

“Electronic prescribing is very widespread with many institutions and some states requiring it,” says co-author Katharine Phillips, MD, professor of psychiatry and residency research director for the Department of Psychiatry at Weill Cornell Medicine and attending psychiatrist at New York-Presbyterian Hospital. “We did the survey and learned that erroneous alerts also seem to be pretty common.”

According to Phillips, what was “particularly surprising and especially problematic” was that some of the warnings from the e-prescribing systems “do not reflect product labeling information from the Food and Drug Administration” and “are not consistent with what the FDA has approved for these medications.”

At the same time, she expresses her concern that as clinicians become inundated with erroneous warnings from these systems “alert fatigue” will set in and they will start to ignore or override clinically valid prescribing problems.

Phillips, who is also adjunct professor of psychiatry and human behavior at Brown University’s Alpert Medical School, contends that additional studies are needed given the increasing use of e-prescribing and potentially harmful patient outcomes from inaccurate warnings.

“At a systems level, this is an issue that needs to be investigated,” she concludes. “It’s just very puzzling how and why these errors get into these systems when all of this information is actually available online in the Physicians’ Desk Reference.”

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