CancelRx: A Health IT Tool to Decrease Medication Discrepancies in the Outpatient Setting

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Successful implementation of CancelRx, an e-prescribing functionality to electronically communicate medication discontinuation orders between electronic health records and pharmacies, can improve medication safety and reduce adverse drug events.

Project Details -
Completed

While the implementation and enhancement of digital healthcare tools has made significant strides in addressing medication safety, adverse drug events (ADEs) are still a common occurrence among those taking prescription medication, resulting in $8 billion in healthcare expenditures annually. Miscommunication in medication discontinuation plays a critical role in this issue. When prescribers discontinue prescriptions in the electronic health record (EHR), these medication discontinuation orders are generally not electronically communicated to the pharmacy. It becomes incumbent on busy clinic staff to notify pharmacies of discontinuations. Despite being removed from the EHR, these medications remain on the pharmacy’s list and can be dispensed to patients, including those that may have been discontinued due to a serious ADE.

CancelRx is an e-prescribing tool to electronically communicate medication discontinuation orders between EHRs and pharmacies, allowing for accurate pharmacy medication lists. The research team evaluated the impact of implementing CancelRx at a large academic healthcare system, and assessed the effectiveness of decreasing ADEs by reducing the dispensing of discontinued medications.

The specific aims of the research were as follows:

  • Measure the impact of CancelRx on reducing medication discrepancies in the pharmacy management software. 
  • Describe the impact of CancelRx implementation on outpatient clinic and community pharmacy work systems. 

This study evaluated the CancelRx implementation at UW Health, a large academic healthcare system serving over 600,000 patients in the Upper Midwest, with 80 outpatient clinics and 15 community pharmacies. The research team used an interrupted time series analysis to evaluate the effectiveness of CancelRx to decrease medication discrepancies as described in the first aim. Data collection occurred over a 12-month pre- and post-intervention period, extracting data of patients aged 18 and older who had one or more medication discontinuations from an e-prescription order from an EHR. The second aim was addressed through interviews and observations with both pharmacists and clinic staff to assess the workflow and communication process of medication cancelations.

The team found that before the implementation of CancelRx, only 34 percent of medications that were canceled at the clinic were also canceled at the pharmacy. Immediate and significant increase in successful medication cancelations occurred after implementation, raising the rate of proper discontinuations up to 93 percent. Interviews revealed the inconsistencies of medication cancelation communication, resulting in the need for a standardized workflow to streamline the process. Participants interviewed also recognized the importance of CancelRx in relation to patient safety, and agree that the successful implementation of this prescription cancelation functionality can improve medication safety. The significant increase in medication discontinuations offers fewer opportunities for discrepancies or inappropriate medication refills, and in turn, can reduce ADEs.

Improving Medication Safety with Accurate e-Prescribing Tool

Improving Medication Safety with Accurate e-Prescribing Tool

Successful implementation of CancelRx, an e-prescribing functionality to electronically communicate medication discontinuation orders between electronic health records and pharmacies, can improve medication safety and reduce adverse drug events.

Principal Investigator: Chui, Michelle Anne
Organization: University of Wisconsin - Madison
Research Profile: CancelRx: A Health IT Tool to Decrease Medication Discrepancies in the Outpatient Setting
Funded Amount: $285,897

Catching medication mishaps at the source

When providers discontinue patients’ medication in the electronic health record (EHR), clinic staff must manually notify the prescribing pharmacies. Busy staff often overlook this notification step and, despite being removed from the EHR, medications may remain on a pharmacy’s dispensing profile for patients. Dr. Michelle Chui recognized this miscommunication can cause a variety of issues, including confusion by the patient or potential adverse drug events. With a pharmacy background and years of research on reducing medication discrepancies, Dr. Chui explored existing technology that can facilitate communication between providers and pharmacists, yielding positive results.

Bridging the gap of miscommunication

CancelRx is an e-prescribing tool that electronically communicates medication discontinuation orders between EHRs and pharmacies. The technology allows pharmacists to have the most up-to-date prescription information, ensuring that a patient’s medication list in a pharmacist’s system is accurate. Through a direct notification, CancelRx prompts a patient’s pharmacy when a provider discontinues a patient’s prescription. Understanding the pressure pharmacists can feel as the “last line of defense” to detect and identify errors for patient medications, Dr. Chui recognizes the significance this tool has—not only to reduce adverse drug events, but to also ensure medical professionals have access to timely data for their patients.

Ultimately, the e-prescribing tool CancelRx helps pharmacists do the job that they want to do, and do it safely and confidently with their patient population.”
- Dr. Chui

Immediate success

Dr. Chui and her University of Wisconsin-Madison-based team found an immediate and significant increase in successful medication cancelations after CancelRx implementation, raising the rate of proper discontinuations from 34 percent to 93 percent. Pharmacists recognized the importance of CancelRx and agreed that the successful implementation of this prescription cancelation functionality can improve medication safety. Dr. Chui feels this tool is a model that can have significant impact in reducing medication discrepancies, enhancing patient safety, and providing a sense of security to prescribing providers and pharmacists on knowing their patients’ most up-to-date medication information.