Houston—New York became the first state earlier this year to require that all prescriptions be electronic, and hospitals around the country, anticipating that more states will enact similar laws, are trying to ensure that their discharge medications meet that format.

A study published recently in the journal Pediatrics reports the results of an effort to improve the frequency of e-prescribing of discharge prescriptions at a children’s hospital using a bundle of quality-improvement interventions.

Even though Texas is not one of the states currently requiring e-prescriptions, a team from Texas Children’s Hospital conducted surveys and focus groups with patients’ families and pediatric residents to identify barriers and propose solutions to increase e-prescribing.

The data were used to promulgate a series of interventions:
• Provider education
• Changes in patient-registration workflow
• Electronic health-record changes to improve the frequency of e-prescribing on the pediatric hospital medicine (PHM) service.

The key measure was e-prescribing frequency, balanced with a calculation of e-prescribing errors, according to the study team.

Results indicate that, from July 2014 through June 2015, e-prescribing frequency on the PHM service improved from a median of 7.4% to 48.9%. The improvement was sustained for an additional 6 months, until December 2015, surpassing meaningful-use targets with associated US News and World Report hospital ranking points, the authors point out.

At the same time, they report, the frequency of PHM prescription errors remained unchanged.

Used for comparison, the resident outpatient clinic revealed no statistically significant change in e-prescribing frequency during the time period.

“Engaging front-line providers in hospital-wide initiatives and quality improvement interventions can directly affect hospital metrics in programs such as meaningful use and US News and World Report, as shown through successful improvement in PHM e-prescribing frequency,” study authors conclude. “Future studies are necessary to determine whether increased e-prescribing frequency affects patient outcomes and compliance.”

As of earlier this year, New York became the first state to mandate that practitioners use e-prescribing for both controlled and noncontrolled substances. Maine mandates e-prescribing for controlled substances, while other states have enacted, but don’t enforce or are considering, similar laws.

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