Underuse of Electronic Health Record Features—The Case for CancelRx

Nelson, Scott D.; Kumah-Crystal, Yaa

doi:10.1001/jamainternmed.2021.4878

JAMA Intern Med

2021

DOI: 10.1001/jamainternmed.2021.4878

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Underuse of Electronic Health Record Features—The Case for CancelRx

Scott D. Nelson

Yaa Kumah-Crystal

Abstract: We thank the patient for granting permission to publish this information. We thank Andrew M. Davis, MD, MPH, University of Chicago, for his generous guidance and insight throughout the development of the manuscript. No compensation was received for these contributions.

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Cited by 5 publications

(11 citation statements)

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“…However, adoption of CancelRx has been slower than adoption of e-prescribing, and this functionality remains underused. 6 In previous studies within academic health systems, more than 90% of CancelRx transactions resulted in a successful cancellation. 7,8 Implementation of CancelRx was associated with reduced discrepancies between health system and pharmacy medication lists, 8 but the association of CancelRx with medication dispensing has only been measured in a pilot study.…”

mentioning

confidence: 98%

“…In 2006, the National Council for Prescription Drug Programs (NCPDP) added CancelRx to the SCRIPT standard for e-prescribing. 6 When implemented, CancelRx enables EHRs to send electronic cancellation messages for e-prescriptions through the health information network to a pharmacy, in a process similar to e-prescribing. However, adoption of CancelRx has been slower than adoption of e-prescribing, and this functionality remains underused.…”

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confidence: 99%

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Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation

Pitts,

Olson,

Yanek

et al. 2023

JAMA Intern Med

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ImportanceAn estimated 1.5% to nearly 5% of medications are dispensed after discontinuation in the electronic health record (EHR), with 34% meeting criteria for high risk of potential harm.ObjectiveTo evaluate the association of the implementation of e-prescription cancellation messaging (CancelRx) with medication dispensing after discontinuation of e-prescriptions in the EHR.Design, Setting, and ParticipantsThis case series with interrupted time series analysis included patients who had at least 1 medication e-prescribed in ambulatory care to a health system pharmacy and discontinued in the 2-year study period from 1 year prior to approximately 1 year after CancelRx implementation (January 15, 2018, to December 7, 2019). Prior to CancelRx implementation, changes to e-prescribed medications within the EHR were not electronically communicated to health system pharmacies, which used separate pharmacy management software. Statistical analysis was performed from November 2020 to June 2023 (primary analysis from March 2021 to May 2022).ExposureImplementation of CancelRx.Main Outcomes and MeasuresThe primary outcome was the proportion of e-prescribed medications dispensed and sold to patients by pharmacies within 6 months after discontinuation in the EHR. A medication was defined as dispensed after discontinuation if the timestamp of dispensing was at least 1 minute and less than 6 months after the timestamp of discontinuation in the EHR. A secondary outcome was the proportion of discontinued medications that was reordered within 120 days.ResultsA total of 53 298 qualifying e-prescriptions that were discontinued were identified for 17 451 unique patients (mean [SD] age, 50.6 [18.2] years; 9332 women [53.5%]). After CancelRx implementation, 22 443 (85.9%) of the 26 127 discontinued e-prescriptions resulted in a CancelRx transaction. In interrupted time series analysis, the proportion of prescriptions dispensed after discontinuation decreased from a baseline of 8.0% (2162 of 27 171) to 1.4% (369 of 26 127; P &lt; .001), without a significant week-to-week trend (β = 0.000158; P = .37).Conclusions and RelevanceIn this case series with interrupted time series analysis, findings suggest that CancelRx implementation was associated with an immediate and persistent reduction in the proportion of e-prescriptions sold after discontinuation in the EHR. Widespread implementation of CancelRx may significantly improve medication safety through the reduction of medication dispensing after discontinuation by prescribers.

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mentioning

confidence: 98%

mentioning

confidence: 99%

Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation

Pitts,

Olson,

Yanek

et al. 2023

JAMA Intern Med

View full text Add to dashboard Cite

show abstract

“…This reduction highlights the importance of implementing CancelRx in e-prescription systems, which unfortunately only few health systems have done. 2 According to Surescripts, a major company that supports electronic transmission of prescriptions, only an estimated 56.7% of prescribers and 84.0% of pharmacies had CancelRx enabled in 2020. 3 Currently, e-prescriptions are a dominant method of prescribing.…”

mentioning

confidence: 99%

Canceling Discontinued Electronic Prescriptions

Zhang,

Grady

2023

JAMA Intern Med

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“…Although eprescribing has widespread adoption, CancelRx, a functionality that allows EHRs to send electronic prescription discontinuation messages to pharmacies, has lagged in adoption. 2 This gap in electronic communication between prescribers and pharmacies contributes to ADEs and patient harm from dispensing errors, with 1.5% to 5% of medications dispensed after intended discontinuation. [3][4][5] In one study, 34% of medications dispensed after discontinuation were classified as high-risk medications, with potential harm identified in 12%.…”

mentioning

confidence: 99%

“…Preventable ADEs occur during prescribing, dispensing, and administration despite safety improvements resulting from electronic prescribing and decision support in electronic health records (EHRs). Although e-prescribing has widespread adoption, CancelRx, a functionality that allows EHRs to send electronic prescription discontinuation messages to pharmacies, has lagged in adoption 2 . This gap in electronic communication between prescribers and pharmacies contributes to ADEs and patient harm from dispensing errors, with 1.5% to 5% of medications dispensed after intended discontinuation 3–5 .…”

mentioning

confidence: 99%

The Impact of Electronic Communication of Medication Discontinuation (CancelRx) on Medication Safety: A Pilot Study

et al. 2022

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ObjectivesThis study aimed to evaluate the impact of electronic communication of medication discontinuation from prescribers to pharmacies (CancelRx) on medication safety.MethodsWe used electronic health record (EHR) data to identify medications that were e-prescribed from a pilot practice to a health system pharmacy and subsequently discontinued before or after CancelRx implementation (January 16–April 15, 2018 versus 2019). We matched these EHR data to pharmacy management software data to identify medications that were sold to patients in the 6 months after discontinuation. As a surrogate for unintended cancellation, we also identified medications refilled within 120 days of discontinuation. We conducted a medical record review to identify documentation of prescriber intent to discontinue these medications.ResultsCancelRx implementation prevented prescriptions from being sold after discontinuation in the EHR (42 of 392 [10.7%] versus 0 of 387 [0.0%], P < 0.0001), but only 15 of 42 (35.7%) had documented intent to discontinue the medication (15 of 392, or 3.8% overall). There was a nonsignificant increase in the proportion of discontinued medications reordered within 120 days (10.0% versus 12.7%, P = 0.23). Medical record review of reordered prescriptions after CancelRx implementation found that 10 of 49 (10 of 387, or 2.6% overall) might have been unintentionally canceled.ConclusionsImplementation of CancelRx eliminated the sale of e-prescribed medications after discontinuation in the EHR but might result in the unintentional cancellation of some prescriptions. Strategies to increase situational awareness of providers and pharmacy staff, including increased visibility of CancelRx, clear distinctions between active and expired prescriptions, and transmission of the reason for discontinuation, might reduce the risk of unintentional cancellations.

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Underuse of Electronic Health Record Features—The Case for CancelRx

Abstract: We thank the patient for granting permission to publish this information. We thank Andrew M. Davis, MD, MPH, University of Chicago, for his generous guidance and insight throughout the development of the manuscript. No compensation was received for these contributions.

Cited by 5 publications

References 6 publications

Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation

Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation

Canceling Discontinued Electronic Prescriptions

The Impact of Electronic Communication of Medication Discontinuation (CancelRx) on Medication Safety: A Pilot Study

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