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Electronic Health Records

Electronic Health Record Interoperability—Why Electronically Discontinued Medications Are Still Dispensed

Educational Objective
To describe implications of electronic prescription programs used within electronic health records and pharmacy systems and the resulting risks of dispensing of discontinued medications.

1 Credit CME

JAMA Internal Medicine

Published Online: August 30, 2021

Teachable Moment

Article Information and Disclosures

Saira Shervani, MD¹;

William Madden, PharmD²;

Lauren J. Gleason, MD, MPH¹

Author Affiliations

¹Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
²Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois

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A 69-year-old woman with a history of epilepsy presented to the emergency department (ED) for recurrent falls, gait instability, and emesis during the previous 3 months. A recent hospital admission had failed to uncover a clear cause of her falls, one of which led to an eye laceration and hand fracture that required an inpatient rehabilitation stay. Her seizures were historically well controlled while taking levetiracetam, although phenytoin was added after a seizure, which was later determined to be secondary to running out of levetiracetam. As a result, her neurologist discontinued phenytoin in the electronic health record (EHR) 6 months prior to her most recent admission and recommended treatment with levetiracetam only. The patient reported she was unaware of this change and had been taking both medications, as each continued to be dispensed by her pharmacy.

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Article Information

Corresponding Author: Saira Shervani, MD, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637 (sairashervani@gmail.com).

Published Online: August 30, 2021. doi:10.1001/jamainternmed.2021.4881

Conflict of Interest Disclosures: Dr Gleason was supported in part by the Health Resources and Services Administration, an operating division of the US Department of Health and Human Services, under grants K01HP39479, U1QHP28728, and T1MHP39062.

Additional Contributions: 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.

References

Schulte F , Fry E . Death by 1,000 clicks: where electronic health records went wrong. Accessed December 15, 2020. https://fortune.com/longform/medical-records/

Dhavle AA , Yang Y , Rupp MT , Singh H , Ward-Charlerie S , Ruiz J . Analysis of prescribers’ notes in electronic prescriptions in ambulatory practice. JAMA Intern Med. 2016;176(4):463-470. doi:10.1001/jamainternmed.2015.7786 PubMed Google Scholar Crossref

Fischer S , Rose A . Responsible e-prescribing needs e-discontinuation. JAMA. 2017;317(5):469-470. doi:10.1001/jama.2016.19908 PubMed Google Scholar Crossref

Allen AS , Sequist TD . Pharmacy dispensing of electronically discontinued medications. Ann Intern Med. 2012;157(10):700-705. doi:10.7326/0003-4819-157-10-201211200-00006 PubMed Google Scholar Crossref

Copi EJ , Kelley LR , Fisher KK . Evaluation of the frequency of dispensing electronically discontinued medications and associated outcomes. J Am Pharm Assoc (2003). 2018;58(4S):S46-S50. doi:10.1016/j.japh.2018.04.015 PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.