Free-text notes field in e-prescriptions causing confusion, study finds

The free-text notes section in e-prescriptions is designed to facilitate increased communication between physicians and pharmacists. However, a new qualitative study published in JAMA suggests the field is often used ineptly and is a common source of confusion.

For the study, three pharmacy technicians analyzed 26,341 ambulatory e-prescriptions extracted randomly from 3,024,737 e-prescriptions with free-text notes that had been sent to pharmacies over a one-week period in 2013. The researchers then analyzed the free-text note fields to determine if the space was utilized effectively.

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The researchers found that 66.1 percent of the free-text notes contained inappropriate content, or information that should have been contained in the correct data-entry field in accordance with the National Council for Prescription Drug Programs e-prescribing standards. Additionally, 5.3 percent of the notes contained information deemed unnecessary to pharmacists. Just 28.6 percent of the note fields were utilized correctly.

The researchers concluded that 19 percent of the inappropriately filled out free-text notes presented potential safety concern because their content included patient directions that conflicted with instructions put forth in the correct designated standard field of the e-prescription.

Researchers suggest the results display a need for improved e-prescription user training and rigorous evaluation and monitoring of EHR and e-prescribing software as well as further application and adoption of specific e-prescribing standards.

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