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

Project Details - Ongoing

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Summary:

Despite the implementation of health information technology (IT) targeting medication safety, one factor that contributes to the occurrence of adverse drug events (ADEs) is the dispensing of medications that have been discontinued. When prescribers discontinue prescriptions in the electronic health record (EHR), these medication discontinuation orders are generally not electronically communicated to the pharmacy. It thus becomes incumbent on busy clinic staff to notify pharmacies of discontinuations. Thus, despite being removed from the EHR, these medications remain on the pharmacy’s list and are able to be dispensed to patients. A patient may receive and continue to take these medications, including those that may have been discontinued due to a serious ADE.

CancelRx is an e-prescribing standard for functionality to electronically communicate medication discontinuation orders between EHRs and pharmacies, allowing for accurate pharmacy medication lists. For over a decade, the National Council for Prescription Drug Programs (NCPDP), which creates pharmacy health IT standards, has recommended its implementation. This project will evaluate the impact of implementing CancelRx at a large academic healthcare system. The researchers hypothesize that this implementation will decrease preventable ADEs by reducing the dispensing of discontinued medications.

The specific aims of the project are 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 mixed methods study will take advantage of a 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. Healthlink EHR (Epic) was implemented at UW Health in 2006, and UW Health community pharmacies implemented a common pharmacy management system in 2008. A pre-post interrupted time series design will be used to determine if medications electronically discontinued in the EHR are successfully removed from the pharmacy management software. Observations and interviews will be conducted to understand the intervention’s impact on the work processes, workflow, and workload in the outpatient clinics and pharmacies.

CancelRx has the potential to reduce medication discrepancies in the pharmacy management software and improve medication safety. Results of the research will support successful implementation and dissemination of CancelRx at other healthcare institutions and settings, with the goal of improving medication safety by reducing adverse drug events caused by the dispensing of discontinued medications.

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