The Development and Piloting of the Ambulatory Electronic Health Record Evaluation Tool: Lessons Learned

Abstract

Background Substantial research has been performed about the impact of computerized physician order entry on medication safety in the inpatient setting; however, relatively little has been done in ambulatory care, where most medications are prescribed. Objective To outline the development and piloting process of the Ambulatory Electronic Health Record (EHR) Evaluation Tool and to report the quantitative and qualitative results from the pilot. Methods The Ambulatory EHR Evaluation Tool closely mirrors the inpatient version of the tool, which is administered by The Leapfrog Group. The tool was piloted with seven clinics in the United States, each using a different EHR. The tool consists of a medication safety test and a medication reconciliation module. For the medication test, clinics entered test patients and associated test orders into their EHR and recorded any decision support they received. An overall percentage score of unsafe orders detected, and order category scores were provided to clinics. For the medication reconciliation module, clinics demonstrated how their EHR electronically detected discrepancies between two medication lists. Results For the medication safety test, the clinics correctly alerted on 54.6% of unsafe medication orders. Clinics scored highest in the drug allergy (100%) and drug–drug interaction (89.3%) categories. Lower scoring categories included drug age (39.3%) and therapeutic duplication (39.3%). None of the clinics alerted for the drug laboratory or drug monitoring orders. In the medication reconciliation module, three (42.8%) clinics had an EHR-based medication reconciliation function; however, only one of those clinics could demonstrate it during the pilot. Conclusion Clinics struggled in areas of advanced decision support such as drug age, drug laboratory, and drub monitoring. Most clinics did not have an EHR-based medication reconciliation function and this process was dependent on accessing patients' medication lists. Wider use of this tool could improve outpatient medication safety and can inform vendors about areas of improvement.

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool

“…The Ambulatory EHR Evaluation Tool was developed in 2019 by researchers at the University of Utah, Brigham and Women's Hospital, and the Institute of Health Improvement. 15 Developers of the tool plan to make it publicly available soon and are actively identifying an organization to host the tool. The tool consists of a medication safety test and a medication reconciliation module.…”

“…In response to these safety concerns, the Ambulatory EHR Evaluation Tool was created and piloted with seven outpatient clinics. 15 The tool's purpose was to provide outpatient clinics with an assessment that they can use to measure the ability of their EHR system to detect and prevent common prescriber errors. The tool's methodology mirrors that of the inpatient version of the tool, which is administered by the Leapfrog Group which has been extensively validated.…”

“…In addition, in the tool's medication reconciliation module, although only three clinics had this functionality in their EHR, only one could showcase it during the evaluation. 15…”

“…The evaluation process mirrored the format used in the initial pilot, 15 where we coordinated three teleconference calls with each clinic. During the introductory call, the research team registered the clinics and clinics downloaded the test patients.…”

Reducing Therapeutic Duplication in Inpatient Medication Orders

“…7 Alerts are ubiquitously used as a form of CDS; however, they are not always effective in reducing therapeutic duplications. 8,9 Current literature point to ineffectiveness, but we do not know when alerts may fail to achieve outcomes. Further, only a few studies describe and evaluate the effectiveness of alternative approaches.…”