Electronic Health Records, Electronic Prescribing and Medication Errors: A Systematic Review of Literature, 2000-2014
Naseem Akhtar Qureshi *
General Administration of Research and Studies, Ministry of Health, Riyadh, Saudi Arabia.
Dalal Salem Al-Dossari
Medication Safety Unit, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.
Ibrahim Abdulaziz Al-Zaagi
Pharmaceutical care and Medication Safety, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.
Abdullah Mohammad Al-Bedah
National Center for Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia.
Abdulrahman Nasser Saad Abudalli
Al-Iman General Hospital, Ministry of Health, Riyadh, Saudi Arabia.
Harold G. Koenig
Duke University Medical Center, Durham, NC, USA, and King Abdulaziz University, Jeddah, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Background: The electronic prescribing system, either standalone or embedded in the electronic health record, is a powerful tool in the hands of healthcare providers, as it reduces half of medication errors caused by handwritten prescribing.
Objective: This article synthesizes the international literature on electronic health records (EHRs), e-prescribing (EP) and medication errors (MEs) and provides a platform to World Health Organization Eastern Mediterranean Region (WHO-EMR) countries for implementing EHRs and EP in healthcare system.
Methods: Computer searches of PubMed, MEDLINE, Quertle®, Google Scholar, Web Knowledge and International Pharmacy Abstract databases were conducted for the years 2000–2014 using several single- and combined-keyword strategies, with 184 articles retained for evaluation.
Results: Although e-prescribing integrated with EHR reduces medication errors at all healthcare levels, decreases morbidity and mortality, enhances patient and healthcare provider satisfaction by reducing costs and improving quality of life, it produces different types of medication errors at various stages of the prescription process. An EHR with EP that has a clinical decision support system (CDSS), dose-limit range, drug–drug interaction alert protocols, and formulary decision support helps to improve EP and ensures greater patient safety and other multiple applications.
Conclusion: EHRs with EP systems should be implemented in healthcare systems for the sake of better quality healthcare and patient safety throughout the WHO-EMR countries especially in the Kingdom of Saudi Arabia. Evidently there is limited data in these countries and hence further studies are needed to assess impact of EHRs and EP system (EPSs) on medication errors, quality of healthcare, patient safety and outcome, morbidity and mortality rates, patients’ and healthcare providers’ acceptance, and especially its cost-effectiveness.
Keywords: e-prescribing system, electronic health records, clinical decision support systems, dose-limit range, drug–drug interactions, medication errors, Saudi Arabia