Understanding CancelRX: Impact on Clinical Workflows, Medication Safety Risks, and Patient Outcomes

Communication of medication discontinuation between prescribers and pharmacies is critical to medication management and preventing adverse drug events (ADEs). When prescribers discontinue medications in the electronic health record (EHR), these changes are generally not communicated to the pharmacy. Consequently, these medications often remain on the pharmacy’s current medication list for the patient and are able to be dispensed to the patient. This can result in a patient receiving and continuing to take no-longer-prescribed medications, including those discontinued due to serious ADEs.

CancelRx is an e-prescribing standard for functionality to electronically communicate medication discontinuation orders (e-cancellations) between EHRs and pharmacies. While CancelRx is recommended as a tool to reduce medication errors, pilot implementations showed limitations. The standard only works for electronically sent cancellations between EHRs and pharmacies that are linked. Thus, a gap remains when prescriptions are printed, when prescriptions are reconciled from outside sources, or for medications a patient reports taking that have not been electronically prescribed. This research will determine key safety and usability issues with CancelRx, develop strategies to address these issues, and measure the impact of e-cancellation on incorrect medication dispensing.

The specific aims of the research are as follows:

• Develop strategies to optimize CancelRx implementation to support patients in medication management and identify areas where further health information technology (IT) development is needed. 
• Measure the impact of CancelRx on patient outcomes, including dispensing errors and documented ADEs following medication discontinuation. 

This research will inform the medical communities, health IT communities, and stakeholders of the benefits and challenges of e-cancellations and establish methods for further evaluation of CancelRx implementation and its impact with community partners. Future studies will be needed to obtain real-time measures of patient harm following dispensing errors and to inform improvements to e-cancellation to maximize safety and usefulness of the CancelRx tool.