Impact of Electronic Health Record Interface Design on Unsafe Prescribing of Ciclosporin, Tacrolimus, and Diltiazem: Cohort Study in English National Health Service Primary Care.
Impact of Electronic Health Record Interface Design on Unsafe Prescribing of Ciclosporin, Tacrolimus, and Diltiazem: Cohort Study in English National Health Service Primary Care.
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DOI：
10.2196/17003
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发表时间：
2020-10-16
影响因子：
7.4
通讯作者：
Goldacre B
中科院分区：
文献类型：
--
作者：
MacKenna B;Bacon S;Walker AJ;Curtis HJ;Croker R;Goldacre B
在英国，国家安全指南建议使用环孢素、他克莫司和地尔硫卓的商品名，因为它们的治疗窗较窄，并且对于他克莫司来说，可以减少器官移植排斥的机会。各种小型研究表明，电子健康记录 (EHR) 系统界面的变化可能会影响处方选择。我们的目标是评估 EHR 系统违反环孢素、他克莫司和地尔硫卓处方安全指南的变化，并对此类违规的原因进行用户界面研究。我们利用英国初级保健的处方数据进行了一项回顾性队列研究。参与者是英国全科医生及其各自的 EHR 系统。主要结果指标是（1）所有实践中安全违规与遵守处方的比率的变化，以及（2）对 EHR 系统使用情况的观察描述。 2018年共开出环孢素、他克莫司、地尔硫卓（60毫克以上）处方2,575,411张；其中，316,119 份处方违反了 NHS 指导方针（12.27%）。违规行为在 EMIS EHR 系统的用户中最为常见（18.81% 的环孢素和他克莫司处方违规，17.99% 的地尔硫卓处方违规），但在所有 EHR 系统中都观察到违规行为。 EHR 系统的设计选择强烈影响环孢素、他克莫司和地尔硫卓的安全处方，而违规行为在英格兰的一般实践中很普遍。我们建议所有电子病历供应商审查其系统，以根据国家指导提高这些药物的安全处方。现在几乎所有的临床实践都是通过 EHR 系统进行的；早就应该对 EHR 系统设计对临床实践的影响进行进一步的定量研究。
In England, national safety guidance recommends that ciclosporin, tacrolimus, and diltiazem are prescribed by brand name due to their narrow therapeutic windows and, in the case of tacrolimus, to reduce the chance of organ transplantation rejection. Various small studies have shown that changes to electronic health record (EHR) system interfaces can affect prescribing choices. Our objectives were to assess variation by EHR systems in breach of safety guidance around prescribing of ciclosporin, tacrolimus, and diltiazem, and to conduct user-interface research into the causes of such breaches. We carried out a retrospective cohort study using prescribing data in English primary care. Participants were English general practices and their respective EHR systems. The main outcome measures were (1) the variation in ratio of safety breaches to adherent prescribing in all practices and (2) the description of observations of EHR system usage. A total of 2,575,411 prescriptions were issued in 2018 for ciclosporin, tacrolimus, and diltiazem (over 60 mg); of these, 316,119 prescriptions breached NHS guidance (12.27%). Breaches were most common among users of the EMIS EHR system (breaches in 18.81% of ciclosporin and tacrolimus prescriptions and in 17.99% of diltiazem prescriptions), but breaches were observed in all EHR systems. Design choices in EHR systems strongly influence safe prescribing of ciclosporin, tacrolimus, and diltiazem, and breaches are prevalent in general practices in England. We recommend that all EHR vendors review their systems to increase safe prescribing of these medicines in line with national guidance. Almost all clinical practice is now mediated through an EHR system; further quantitative research into the effect of EHR system design on clinical practice is long overdue.
荷兰长老的共同处方NSAID和胃保护药物的质量及其与电子病历的关联。
影响因子：
3.7
作者：
Opondo D;Visscher S;Eslami S;Verheij RA;Korevaar JC;Abu-Hanna A
通讯作者：
Abu-Hanna A