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Computerised prescribing for safer medication ordering: still a work in progress
  1. Gordon D Schiff1,
  2. Thu-Trang T Hickman2,
  3. Lynn A Volk3,
  4. David W Bates1,3,
  5. Adam Wright1,4
  1. 1Department of General Medicine, Brigham and Womens Hospital, Boston, Massachusetts, USA
  2. 2Division of General Internal Medicine and Primary Care Brigham and Womens Hospital, Boston, Massachusetts, USA
  3. 3Department of Clinical Quality and Analysis, Partners Healthcare System, Wellesley, Massachusetts, USA
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Gordon D Schiff, Department of General Medicine, Brigham and Womens Hospital, 1620 Tremont, 3rd Floor, Boston, Massachusetts 02120, USA; gschiff{at}

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Fuelled by compelling evidence that computerised provider order entry (CPOE) improves medication safety and the infusion of tens of billions of federal electronic medical record (EMR) stimulus dollars, electronic medication prescribing in the USA has gone from <10% to >70% of prescriptions being written electronically in just the past six years.1–4 Most medications are now ordered electronically both inside and outside the hospital, and they are being sent in electronically to pharmacies. Although many of the initial obstacles to the widespread adoption of CPOE such as physician resistance, lack of standards for electronically transmitting prescriptions to pharmacies and lack of standards for drug databases (leading some organisations to resort to ‘home-grown’ solutions) have been largely overcome, CPOE remains a work in progress. A series of studies by the U.S. Institute of Medicine and Office of the National Coordinator for Health Information Technology (HIT) have recently spotlighted a number of potential safety risks.5–7

To better understand these risks and the opportunities for improvement, particularly as they relate to drug names and drug ordering, the U.S. Food and Drug Administration Center for Drug Evaluation and Research's Division of Medication Error Prevention and Analysis contracted the Brigham and Women's Hospital (BWH) Center for Patient Safety Research and Practice to study CPOE and risks that could potentially lead to medication errors.

The findings from this 2-year investigation have recently been compiled into a White Paper entitled Computerized Prescriber Order Entry Medication Safety (CPOEMS): Uncovering and Learning from Issues and Errors.8 It documents issues about which policy and patient safety leaders, along with clinicians, pharmacists and patients, need to be aware to minimise the risk of CPOE-related errors. Here, we share the main findings and our own perspectives based on this review of 10 CPOE systems (four inpatient, six outpatient) at six …

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  • Twitter Follow David Bates at @dbatessafety

  • Contributors GDS, T-TTH, AW: writing of the manuscript, data analysis and review. LAV: critical review of the manuscript and overseeing the administrative aspects of the project. DWB: critical review of the manuscript, provided ideas and important concepts included in the manuscript.

  • Funding US Food and Drug Administration (HHSF223201000008I/HHSF22301005T).

  • Competing interests DWB is a co-inventor on patent no. 6029138 held by Brigham and Women's Hospital on the use of decision support software for medical management, licensed to the Medicalis Corporation. He holds a minority equity position in the privately held company Medicalis, which develops web-based decision support for radiology test ordering. He consults for EarlySense, which makes patient safety monitoring systems.

  • Ethics approval Partners IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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