MOUNT SINAI JOURNAL OF MEDICINE 78:827–833, 2011
Effect of E-Prescribing Systems on
Patient Safety
Joseph Kannry, MD
EHR Clinical Transformation Project, Mount Sinai Medical Center, New York, NY
OUTLINE
DEFINING E-PRESCRIBING WITH AND WITHOUT
MEDICATION DECISION SUPPORT
EFFECT OF E-PRESCRIBING ON PATIENT SAFETY
Earliest e-Prescribing Systems
E-Prescribing With Medication Decision
Support
DISCUSSION
CONCLUSION
ABSTRACT
E-prescribing systems enable electronic transmissions
of prescriptions to pharmacies from the provider’s
office. The promise of e-prescribing in regard to
patient safety is reduction in the time gap between
point of care and point of service, reduction in medi-
cation errors, and improved quality of care. This arti-
cle will give a brief overview of e-prescribing systems,
what is known about these systems and their impact
on patient safety, and what challenges remain. For
purposes of this article, the term ‘‘patient safety’’ will
be used interchangeably with medication errors and
adverse drug events. Although there is some evidence
that e-prescribing alone and e-prescribing with medi-
cation decision support can reduce medication errors,
there is also evidence that e-prescribing can be a
source of medication errors. The need for more study
is particularly relevant and timely, as the Centers for
Medicare and Medicaid Services is strongly incentiviz-
ing providers to use e-prescribing with medication
decision support. Despite concerns about efficiency
Address Correspondence to:
Joseph Kannry
Mount Sinai Medical Center
New York, NY
Email: joseph.kannry@mountsinai.org
Published online in Wiley Online Library (wileyonlinelibrary.com).
DOI:10.1002/msj.20298
 2011 Mount Sinai School of Medicine
827
and dissatisfaction, the majority of providers believe
e-prescribing provides for improved patient safety.
Limited evidence suggests that e-prescribing with
medication decision support can improve patient
safety. Mt Sinai J Med 78:827–833, 2011.  2011
Mount Sinai School of Medicine
Key Words: adverse drug events, ambulatory care,
electronic health records, electronic medical records,
e-prescribing, medication safety, patient safety.
The simplest definition of an e-prescribing system
is a system that enables electronic transmissions
of prescriptions to pharmacies from the provider’s
office,1 and this definition was reiterated in 2010.2
E-prescribing was intended to improve patient safety
through elimination of the time gap between provider
office and pharmacy, reduction of medication errors,
improvements in quality of care and higher patient
satisfaction,3 as well as reductions in illegible
prescriptions.4,5 This article will give a brief expert
overview of e-prescribing systems, what is known
about these systems and their impact on patient
safety, and what challenges remain. For purposes of
this article, the term ‘‘patient safety’’ will be used
interchangeably with medication errors and adverse
drug events (ADEs).
The simplest definition of an
e-prescribing system is a system that
enables electronic transmissions
of prescriptions to pharmacies
from the provider’s office.
DEFINING
E-PRESCRIBING WITH AND WITHOUT
MEDICATION DECISION SUPPORT
The earliest e-prescribing systems simply provided
the ability to send prescriptions electronically.2 There
828 J. KANNRY: E-PRESCRIBING SYSTEMS AND PATIENT SAFETY

are 2 types of e-prescribing systems: stand alone Table 1. Types of Medication Decision Support.
e-prescribing systems and EHR (electronic health Type What It Checks For
record) integrated e-prescribing systems. Almost
all e-prescribing systems today include medication Drug-drug interaction Dangerous interactions
between medications
decision support (MDS), decision support to help Drug-allergy interaction Allergies to prescribed
the provider avoid medication errors and ADEs. medication
Medication decision support includes drug-drug, Drug-laboratory Laboratory tests to be
drug-allergy, drug-disease/drug-laboratory, cost, and monitored or laboratory
dose checking, as well as default dosing.6,7 See abnormalities requiring
discontinuation of
Table 1 for a complete list of the types of MDS. medication
Drug-disease Diseases requiring changes in
Almost all e-prescribing systems medication usage
Drug-dosing guidance Doses that are too high or low
today include medication decision Drug-dose calculation Drugs requiring weight-based
support, decision support to help calculations
Renally adjusted dosing Renal function that requires
the provider avoid medication changes in dosing
errors and adverse drug events. Geriatric dosing support Age >65 that necessitates
and medication different dosing and
Medication decision support selection medication usage
Duplicate therapy Therapeutically identical
includes drug-drug, drug-allergy, medications (eg, 2 ACE
drug-disease/drug-laboratory, inhibitors)
Drug-pregnancy Pregnancy requiring
cost, and dose checking, as well as adjustment in medications
default dosing. Formulary and benefit Drug plan from insurance
checking company and relative cost
of medications
Shared and Drug claim information and all
comprehensive filled prescriptions including
EFFECT OF medication lists those written for by other
prescribers
E-PRESCRIBING ON PATIENT SAFETY
Abbreviations: ACE, angiotensin-converting enzyme.
Earliest e-Prescribing Systems Adapted from Johnston et al.6,7 and Kuperman et al.55

The earliest e-prescribing systems were systems
that enabled electronic transmissions of prescriptions
to pharmacies from the provider’s office. Provider
reasons for adapting these early e-prescribing systems
were ‘‘the ease of changing doses, renewing
prescriptions, ensuring legibility, and transmitting
prescriptions’’ as well as financial incentives from the
Centers for Medicare and Medicaid Services (CMS).8
These early systems reduced medication errors by
improving legibility and reducing the amount of
missing information.9,10
E-Prescribing With
Medication Decision Support
Evidence suggests that if e-prescribing systems
incorporated MDS, 95% of potential ADEs missed by
simple e-prescribing systems (ie, without MDS) could
be prevented.11 The estimated savings from reducing
ambulatory ADEs through the use of e-prescribing
with MDS is $3.5 billion.12 There is some evidence
that e-prescribing with MDS can reduce medication
errors. A study by Kaushal et al.13 found a significant
reduction in medication errors for providers using
Evidence suggests that if
e-prescribing systems incorporated
medication decision support, 95%
of potential adverse drug events
missed by simple e-prescribing
systems (ie, without medication
decision support) could be
prevented. The estimated savings
from reducing ambulatory adverse
drug events through the use of
e-prescribing with medication
decision support is $3.5 billion.
an e-prescribing system with MDS. Errors studied
included frequency, dose, duration, and strength.
Similarly, a study by Devine et al. found a reduction

DOI:10.1002/MSJ
MOUNT SINAI JOURNAL OF MEDICINE
in ADEs that involved missing information or lack of
appropriate laboratory monitoring.14
However, not all e-prescribing systems with
MDS are alike. There are 2 types of e-prescribing
systems with MDS: stand-alone systems and EHR-
integrated systems. Stand-alone means that the sys-
tem is dedicated to e-prescribing. Electronic health
record–integrated means that the e-prescribing is a
component of the EHR. To improve patient safety,
MDS must not only be enabled, but also be used. The
usage of MDS is significantly different when com-
paring stand-alone and EHR-integrated e-prescribing
systems. Not only were EHR-integrated physicians
more likely to use and respond to MDS than their
stand-alone counterparts, but these same physicians
were more likely to use e-prescribing in general.15,16
For a measurable impact on patient safety,
the most studied types of MDS were drug-
laboratory, drug-disease, and drug-dosing checking.
Drug-laboratory checking identifies medications that
require monitoring (ie, laboratory tests) or medication
orders that should be halted due to the presence of
abnormal laboratory test results. One study reported
a statistically significant increase in laboratory test
ordering, as well as a reduction in medication order-
ing when laboratory tests were abnormal.17 Another
study did find that for a subset of medications,
gemfibrozil and the drug class statins, there was a
statistically significant improvement in monitoring.18
However, neither study was able to demonstrate a
reduction in medication errors or ADEs.
Drug-disease checking alerts the user when
using a drug in a patient with a known disease.
Two studies demonstrated significant reductions in
ADEs and medication errors through the use of drug-
disease checking.19,20
Drug-dosing guidance provides dosing recom-
mendations as the prescription is being written. One
study demonstrated that drug-dosing errors were
avoided in 84% of eligible patients using drug-dosing
guidance developed by consensus.19 A Cochrane
review by Durieux looked at both inpatient and
outpatient settings and found no impact on ADEs
regardless of the setting of care.21
DISCUSSION
This brief review provides some evidence of a reduc-
tion in errors and ADEs by the use of e-prescribing
without MDS. This improvement in patient safety is
due to reductions in illegible prescriptions as well as
prescriptions with incomplete information.9,10 Some
of the improvement may be due to the structured
entry that e-prescribing requires.
829
This brief review provides some
evidence of a reduction in errors
and adverse drug events by the use
of e-prescribing without
medication decision support. This
improvement in patient safety is
due to reductions in illegible
prescriptions as well as
prescriptions with incomplete
information.
There is limited evidence that e-prescribing
with medication decision-making improves patient
safety.13,14 Additionally, there is some evidence that 2
types of MDS, drug-disease and drug-dosing, improve
patient safety when used with e-prescribing.19,20 The
limited literature on e-prescribing with MDS and
patient safety may reflect the fact that e-prescribing
is just a piece of the larger cycle of ambulatory
administration of medications.22,23 The ambulatory
administration cycle has many pieces that are not
easy to control for study. For example, e-prescribing
cannot directly affect self-administration of the
medication in the patient’s home.24 Regardless, there
is clearly a further need for the study of e-prescribing
with MDS and improvements in patient safety.
This need is highlighted by issues around system
integration with workflow and patient information.25
There is limited evidence that
e-prescribing with medication
decision-making improves patient
safety. Additionally, there is some
evidence that 2 types of
medication decision support,
drug-disease and drug-dosing,
improve patient safety when used
with e-prescribing.
There are serious concerns about the utilization
and effectiveness of MDS in stand alone e-prescribing
systems.15,16,23 One late-breaking study in 2011
demonstrated no difference in medication errors with
a stand-alone e-prescribing system with MDS.26 In
contrast, the effective utilization of MDS in EHR-
integrated systems is greater than that of stand-alone
systems.15,16 However, the evidence for reduction of
medication errors/ADEs in EHR-integrated systems is
just as limited14 as it is for stand-alone systems.13
DOI:10.1002/MSJ
830
Despite these differences in patient safety
between the 2 types of e-prescribing with MDS,
getting a provider to switch from a stand-alone
e-prescribing system to an EHR-integrated system
may not be so easy.15 Most of the initial gains in
office efficiency due to e-prescribing, once made in
the stand-alone system, offer little further gain in an
EHR-integrated e-prescribing system. As a result, a
switch to EHR-integrated e-prescribing systems may
be met with a less-than-enthusiastic response.
There are some significant challenges to
providers using e-prescribing with MDS to improve
patient safety. One estimate calculated that it would
take 331 alerts to prevent 1 ADE27 and that only 10%
of alerts are needed to account for 60% of ADEs and
78% of the cost ADEs. E-prescribing with MDS needs
to provide not only fewer alerts, but more specific
and targeted alerts. Multiple studies found that a few
drugs that explain the majority of hospitalizations
from ambulatory ADEs.28 – 30 Targeted alerting could
include subsets of medications30 – 34 ; age, such as geri-
atric patients35,36 ; and disease, such as renal disease.37
Studies clearly demonstrate several areas of
challenge with specific types of MDS during
e-prescribing. For example, drug-drug interaction
(DDI) checking alerts the user to potentially dan-
gerous interactions between prescribed medications.
Multiple studies note significant frustration due to
overwhelming numbers of nonspecific alerts that are
frequently irrelevant.5,38,39 One study found the over-
ride reasons for DDI checking useless.40 The same
frustrations have been expressed for drug-allergy
checking.8,41 It is beyond the scope of this article
to examine the factors contributing to frustration and
the corresponding efforts to improve the acceptance
rate of DDI and drug-allergy checking alerts.
Employing drug-pregnancy checking is particu-
larly problematic, as it is difficult to determine if and
when the patient is pregnant.42 Making the determi-
nation of pregnancy solely based on a positive blood
pregnancy test, beta human chorionic gonadotropin,
is not sufficient. The date of conception is needed
both to determine the beginning of pregnancy as
well as to calculate the expected delivery date, but
this information may be missing or not captured.
Formulary decisions support (FDS) provides
information on which medications are part of a
patient’s drug plan and the relative cost of those
medications. As such, FDS could be a critical tool
in improving patient safety by ensuring that cost is
not a factor in patient compliance. However, FDS is
hampered by a lack of comprehensive and utilized
standards that would automate it.43
Ideally, information from drug-claims databases
should ensure that all prescribers receive information
DOI:10.1002/MSJ
J. KANNRY: E-PRESCRIBING SYSTEMS AND PATIENT SAFETY
on medications the patient is taking, regardless of
what setting of care the patient is seen in or which
EHR is used. If the patient fills a prescription paid
for by any drug plan, there should be information
on that prescription. Knowing that 1 or more of the
prescriptions were filled in and of itself is invaluable
information. For example, say a patient has
uncontrolled blood pressure and it is unclear if the
patient is taking all prescribed medicines. Knowing
that blood pressure prescriptions were not filled
would give an important clue to compliance issues.
However, access to a complete list of medications
from the claims database is far from the case,
with poor workflow integration, lack of universal
identifiers for drugs needed to enable reconciliation
from multiple sources, and ‘‘nonparticipation of
many health plans’’ in the databases.43 Additionally
hampering this goal are a lack of consistent standards
and the utilization of standards where they exist.44
A new topic requiring further study is the
e-prescribing as a source of medication errors. From
2009 onward, 4 studies have demonstrated that
e-prescribing can introduce medication errors. Some
From 2009 onward, 4 studies have
demonstrated that e-prescribing
can introduce medication errors.
of these errors are because of discrepancies between
data fields in the same prescription.45 For example,
a structure field (ie, a list of choices that cannot be
altered) might say to take 1 pill twice a day and the
free-text instructions field might say to take 2 pills
in AM and 1 pill in PM. Surprisingly, other medication
errors were the result of inconsistent drug dosing.46
A 2011 study by Naji et al. found an error rate of 1 in
10 prescriptions, which caused the study authors
to remark that this was the same rate of errors
in handwritten prescriptions.47 The most common
error in the 2011 Naji study was missing information.
Interestingly, the error rate and type of error varied by
the e-prescribing system itself in the study. However,
even in 2011, transitioning to a ‘‘safer’’ e-prescribing
system with MDS may create another significant set
of patient-safety issues.48,49
Studies looking at the relationship of e-
prescribing with MDS to improvements in patient
safety need to involve the pharmacy. The pharma-
cist is the last line of defense50,51 and the target
of e-prescribing by definition. As Bell noted, it is
the pharmacy that is dispensing the medications in
the outpatient medication cycle.22 Further innovation
needs to occur with e-prescribing to enable transmis-
sion of override reasons directly to the pharmacy, as
MOUNT SINAI JOURNAL OF MEDICINE
well as to allow the pharmacy to electronically send
messages back to the e-prescriber. Done correctly,
these 2 innovations would still leave the pharmacy as
safety net, but with appropriate workloads for both
providers and pharmacists. Once implemented, these
2 innovations would make for interesting studies in
e-prescribing and patient safety.
Ironically just as e-prescribing is beginning to
take hold, thanks to the CMS e-prescribing52 and
Meaningful Use EHR incentive programs,53 more and
more prescriptions for chronic diseases are being
shifted to mail-order pharmacy programs. Unlike the
easy way that users can identify pharmacies in an
e-prescribing systems, such as by phone number,
the provider has to wait for automated identification
of a mail-order plan by benefit checking. This
automated identification is not always successful due
to problems with benefit checking.43 Alternatively,
if the provider can identify the mail-order pharmacy
without using benefit checking, a prescription can
be sent electronically by fax. The effect of mail-order
prescribing on e-prescribing with MDS and patient
safety has yet to be studied.
CONCLUSION
E-prescribing systems can have an impact on
patient safety through electronic transmission to the
pharmacy with legible and complete prescriptions.9,10
There is some evidence that e-prescribing with
MDS support improves patient safety, particularly
when e-prescribing is part of an EHR.13,14 There
is additional evidence that 2 types of MDS in
particular, drug-disease and drug-dosing, can reduce
the occurrence of ADEs and medication errors.19,20
However, there is legitimate concern about the
acceptance of MDS alerts, with acceptance rates
as low as 1 in 9.54 Further study is needed on
which types of MDS (eg, drug-laboratory alerts
versus DDI checking) are the most efficacious in
improving patient safety in which populations (eg,
geriatrics) and for which medications. The role of
pharmacist and pharmacy information systems needs
further study as well. More study is needed to
look at medication errors caused by e-prescribing.
The need for more study of all types regarding e-
prescribing and patient safety is particularly relevant
and timely, as CMS is strongly incentivizing providers
to use e-prescribing with MDS. Interestingly, CMS is
specifically mandating 2 types of MDS, drug-drug and
drug-allergy checking, which are sources of a great
deal of frustration.5,8,38,39,41 Despite concerns about
efficiency and effectiveness, the majority of providers
believe e-prescribing provides for improved patient
831
safety.50,54 Limited evidence suggests that e-
prescribing with MDS can improve patient safety.
DISCLOSURES
Potential conflict of interest: Nothing to report.
REFERENCES
1. Medicare program. E-prescribing and the prescription
drug program: final rule. Fed Regist 2005; 70:
67567–67595.
2. Centers for Medicare and Medicaid Services. E-
prescribing. https://www.cms.gov/eprescribing. Pub-
lished 2010. Accessed March 28, 2011.
3. Papshev D, Peterson AM. Electronic prescribing in
ambulatory practice: promises, pitfalls, and potential
solutions. Am J Manag Care 2001; 7: 725–736.
4. Ward-McKnight R, West DS. Electronic prescribing
reduces errors and improves patient safety. J Ark Med
Soc 2007; 104: 60–61.
5. Grossman JM, Gerland A, Reed MC, et al. Physicians’
experiences using commercial e-prescribing systems.
Health Aff (Millwood) 2007; 26: w393–w404.
6. Johnston D, Pan E, Walker J, et al. Patient Safety in the
Physician’s Office: Assessing the Value of Ambulatory
CPOE. Oakland, CA: California HealthCare Founda-
tion; 2004. http://www.chcf.org/publications/2004/04/
patient-safety-in-the-physicians-office–assessing-the-
value-of-ambulatory-cpoe.
7. Johnston D, Pan E, Walker J, et al. The Value of Com-
puterized Provider Order Entry in Ambulatory Settings.
Boston, MA: Center for Information Technology Lead-
ership; 2003.
8. Weingart SN, Massagli M, Cyrulik A, et al. Assessing
the value of electronic prescribing in ambulatory
care: a focus group study. Int J Med Inform 2009;
78: 571–578.
9. Meyer TA. Improving the quality of the order-
writing process for inpatient orders and outpatient
prescriptions. Am J Health Syst Pharm 2000; 57 (suppl
4): S18–S22.
10. Jani YH, Ghaleb MA, Marks SD, et al. Electronic
prescribing reduced prescribing errors in a pediatric
renal outpatient clinic. J Pediatr 2008; 152: 214–218.
11. Gandhi TK, Weingart SN, Seger AC, et al. Outpatient
prescribing errors and the impact of computerized
prescribing. J Gen Intern Med 2005; 20: 837–841.
12. Hillestad R, Bigelow J, Bower A, et al. Can electronic
medical record systems transform health care? Potential
health benefits, savings, and costs. Health Aff
(Millwood) 2005; 24: 1103–1117.
13. Kaushal R, Kern LM, Barron Y, et al. Electronic
prescribing improves medication safety in community-
based office practices. J Gen Intern Med 2010; 25:
530–536.
14. Devine EB, Hansen RN, Wilson-Norton JL, et al. The
impact of computerized provider order entry on
medication errors in a multispecialty group practice.
J Am Med Inform Assoc 2010; 17: 78–84.
DOI:10.1002/MSJ
832
15. Desroches CM, Agarwal R, Angst CM, et al. Differences
between integrated and stand-alone E-prescribing
systems have implications for future use. Health Aff
(Millwood) 2010; 29: 2268–2277.
16. Grossman JM. Even when physicians adopt e-
prescribing, use of advanced features lags. Issue Brief
Cent Stud Health Syst Change 2010; 133: 1–5.
17. Steele AW, Eisert S, Witter J, et al. The effect of
automated alerts on provider ordering behavior in
an outpatient setting. PLoS Med 2005; 2: e255.
18. Palen TE, Raebel M, Lyons E, et al. Evaluation of
laboratory monitoring alerts within a computerized
physician order entry system for medication orders.
Am J Manag Care 2006; 389–395.
19. Wessell AM, Litvin C, Jenkins RG, et al. Medication
prescribing and monitoring errors in primary care:
a report from the Practice Partner Research Network.
Qual Saf Health Care 2010; 19: e21.
20. Devine EB, Wilson-Norton JL, Lawless NM, et al. The
impact of an ambulatory CPOE system on medication
errors. AMIA Annu Symp Proc 2008: 928.
21. Durieux P, Trinquart L, Colombet I, et al. Computer-
ized advice on drug dosage to improve prescribing
practice. Cochrane Database Syst Rev 2008: CD002894.
22. Bell DS, Cretin S, Marken RS, et al. A conceptual
framework for evaluating outpatient electronic
prescribing systems based on their functional
capabilities. J Am Med Inform Assoc 2004; 11: 60–70.
23. Moxey A, Robertson J, Newby D, et al. Computerized
clinical decision support for prescribing: provision
does not guarantee uptake. J Am Med Inform Assoc
2010; 17: 25–33.
24. Kohn L, Corrigan J, Donaldson M, eds.; for Institute
of Medicine, Committee on Quality of Health Care in
America. To Err Is Human: Building a Safer Health
System. Washington, DC: National Academies Press;
2000.
25. Mollon B, Chong J Jr, Holbrook AM, et al. Features
predicting the success of computerized decision
support for prescribing: a systematic review of
randomized controlled trials. BMC Med Inform Decis
Mak 2009; 9: 11.
26. Dainty KN, Adhikari NK, Kiss A, et al. Electronic
prescribing in an ambulatory care setting: a
cluster randomized trial. J Eval Clin Pract 2011;
doi:10.1111/j.1365-2753.2011.01657.x.
27. Weingart SN, Simchowitz B, Padolsky H, et al. An
empirical model to estimate the potential impact of
medication safety alerts on patient safety, health care
utilization, and cost in ambulatory care. Arch Intern
Med 2009; 169: 1465–1473.
28. Howard RL, Avery AJ, Slavenburg S, et al. Which drugs
cause preventable admissions to hospital? A systematic
review. Br J Clin Pharmacol 2007; 63: 136–147.
29. Jha AK, Prasopa-Plaizier N, Larizgoitia I, et al. Patient
safety research: an overview of the global evidence.
Qual Saf Health Care 2010; 19: 42–47.
30. Thomsen LA, Winterstein AG, Søndergaard B, et al.
Systematic review of the incidence and characteristics
of preventable adverse drug events in ambulatory care.
Ann Pharmacother 2007; 41; 1411–1426.
31. Mahmood M, Malone DC, Skrepnek GH, et al. Poten-
tial drug-drug interactions within Veterans Affairs
medical centers. Am J Health Syst Pharm 2007; 64:
1500–1505.
DOI:10.1002/MSJ
J. KANNRY: E-PRESCRIBING SYSTEMS AND PATIENT SAFETY
32. Aparasu R, Baer R, Aparasu A. Clinically important
potential drug-drug interactions in outpatient settings.
Res Social Adm Pharm 2007; 3: 426–437.
33. Field TS, Gurwitz JH, Harrold LR, et al. Risk factors
for adverse drug events among older adults in
the ambulatory setting. J Am Geriatr Soc 2004; 52:
1349–1354.
34. Chan A, Tan SH, Wong CM, et al. Clinically significant
drug-drug interactions between oral anticancer agents
and nonanticancer agents: a Delphi survey of oncology
pharmacists. Clin Ther 2009; 31 (part 2): 2379–2386.
35. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and
preventability of adverse drug events among older
persons in the ambulatory setting. JAMA 2003; 289:
1107–1116.
36. Hume AL, Quilliam BJ, Goldman R, et al. Alternatives
to potentially inappropriate medications for use in
e-prescribing software: triggers and treatment algo-
rithms. BMJ Qual Saf 2011; doi:10.1136/bmjqs.2010.
049635.
37. Gandhi TK, Burstin HR, Cook EF, et al. Drug
complications in outpatients. J Gen Intern Med 2000;
15: 149–154.
38. Lapane KL, Waring ME, Schneider KL, et al. A mixed
method study of the merits of e-prescribing drug alerts
in primary care. J Gen Intern Med 2008; 23: 442–446.
39. Hor CP, O’Donnell JM, Murphy AW, et al. General
practitioners’ attitudes and preparedness towards
Clinical Decision Support in e-Prescribing (CDS-eP)
adoption in the West of Ireland: a cross sectional
study. BMC Med Inform Decis Mak 2010; 10: 2.
40. Grizzle AJ, Mahmood MH, Ko Y, et al. Reasons
provided by prescribers when overriding drug-drug
interaction alerts. Am J Manag Care 2007; 13: 573–578.
41. Isaac T, Weissman JS, Davis RB, et al. Overrides of
medication alerts in ambulatory care. Arch Intern Med
2009; 169: 305–311.
42. Shah NR, Seger AC, Seger DL, et al. Improving
acceptance of computerized prescribing alerts in
ambulatory care. J Am Med Inform Assoc 2006; 13:
5–11.
43. Wang CJ, Patel MH, Schueth AJ, et al. Perceptions
of standards-based electronic prescribing systems as
implemented in outpatient primary care: a physician
survey. J Am Med Inform Assoc 2009; 16: 493–502.
44. Friedman MA, Schueth A, Bell DS. Interoperable
electronic prescribing in the United States: a progress
report. Health Aff (Millwood) 2009; 28: 393–403.
45. Palchuk MB, Fang EA, Cygielnik JM, et al. An
unintended consequence of electronic prescriptions:
prevalence and impact of internal discrepancies. J Am
Med Inform Assoc 2010; 17: 472–476.
46. Singh H, Mani S, Espadas D, et al. Prescription errors
and outcomes related to inconsistent information
transmitted through computerized order entry: a
prospective study. Arch Intern Med 2009; 169:
982–989.
47. Nanji KC, Rothschild JM, Salzberg C, et al. Errors
associated with outpatient computerized prescribing
systems. J Am Med Inform Assoc 2011; doi:10.1136/
amiajnl-2011-000205.
48. Abdel-Qader DH, Harper L, Cantrill JA, et al. Pharma-
cists’ interventions in prescribing errors at hospital
discharge: an observational study in the context of
an electronic prescribing system in a UK teaching
hospital. Drug Saf 2010; 33: 1027–1044.
MOUNT SINAI JOURNAL OF MEDICINE
49. Redwood S, Rajakumar A, Hodson J, et al. Does the
implementation of an electronic prescribing system
create unintended medication errors? A study of the
sociotechnical context through the analysis of reported
medication incidents. BMC Med Inform Decis Mak
2011; 11: 29.
50. Lapane KL, Rosen RK, Dube C. Perceptions of e-
prescribing efficiencies and inefficiencies in ambu-
latory care. Int J Med Inform 2011; 80: 39–46.
51. Varkey P, Aponte P, Swanton C, et al. The effect of
computerized physician-order entry on outpatient
prescription errors. Manag Care Interface 2007; 20:
53–57.
52. Centers for Medicare and Medicaid Services. 2010
eRX measure specification. https://www.cms.gov/ERx
Incentive/06_E-Prescribing_Measure.asp. Published
2010. Updated July 8 , 2011.
833
53. Centers for Medicare and Medicaid Services. Electronic
Health Record (EHR) Incentive Program (CMS-0033-F).
http://www.federalregister.gov/regulations/0938-
AP78/electronic-health-record-ehr-incentive-program-
cms-0033-f-;. Accessed September 5, 2010.
54. Spina JR, Glassman PA, Belperio P, et al. Clinical rele-
vance of automated drug alerts from the perspective
of medical providers. Am J Med Qual 2005; 20: 7–14.
55. Kuperman GJ, Bobb A, Payne TH, et al. Medication-
related clinical decision support in computerized
provider order entry systems: a review. J Am Med
Inform Assoc 2007; 14: 29–40.
DOI:10.1002/MSJ