Suboptimal prescribing behaviour associated with clinical software design features: a retrospective cohort study in English NHS primary care
- 1 September 2020
- journal article
- research article
- Published by Royal College of General Practitioners in British Journal of General Practice
- Vol. 70 (698), E636-E643
- https://doi.org/10.3399/bjgp20X712313
Abstract
Background Electronic health record (EHR) systems are used by clinicians to record patients medical information, and support clinical activities such as prescribing. In England, healthcare professionals are advised to 'prescribe generically' because generic drugs are usually cheaper than branded alternatives, and have fixed reimbursement costs. 'Ghost-branded generics' area new category of medicines savings, caused by prescribers specifying a manufacturer for a generic product, often resulting in a higher reimbursement price compared with the true generic. Aim To describe time trends and practice factors associated with excess medication costs from ghost-branded generic prescribing. Design and setting Retrospective cohort study of English GP prescribing data and EHR deployment data. Method A retrospective cohort study was conducted, based on data from the OpenPrescribing.net database from May 2013 to May 2019. Total spending on ghost-branded generics across England was calculated, and excess spend on ghost-branded generics calculated as a percentage of all spending on generics for every CCG and general practice in England, for every month in the study period. Results There were 31.8 million ghost branded generic items and 9.5 pound million excess cost in 2018, compared with 7.45 million ghost-branded generic items and 1 pound .3 million excess cost in 2014. Most excess costs were associated with one EHR, SystmOne, and it was identified that SystmOne offered ghost-branded generic options as the default. After informing the vendor, the authors monitored for subsequent change in costs, and report a rapid decrease in ghost-branded generic expenditure. Conclusion A design choice in a commonly used EHR has led to 9.5 pound million in avoidable excess prescribing costs for the NHS in 1 year. Notifying the vendor led to a change in user interface and a rapid, substantial spend reduction. This finding illustrates that EHR user interface design has a substantial impact on the quality, safety, and cost-effectiveness of clinical practice; this should be a priority for quantitative research.This publication has 19 references indexed in Scilit:
- New mechanism to identify cost savings in English NHS prescribing: minimising 'price per unit', a cross-sectional studyBMJ Open, 2018
- Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population studyBMJ Open, 2018
- Interpretation of ‘Unnatural Death’ in Coronial Law: A Review of the English Legal Process of Decision Making, Statutory Interpretation, and Case LawMedical Law Review, 2018
- Nudge Units to Improve the Delivery of Health CareThe New England Journal of Medicine, 2018
- Trends and patterns in antibiotic prescribing among out-of-hours primary care providers in England, 2010–14Journal of Antimicrobial Chemotherapy, 2017
- A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary careJournal of the American Medical Informatics Association, 2016
- Generic Medication Prescription Rates After Health System–Wide Redesign of Default Options Within the Electronic Health RecordJAMA Internal Medicine, 2016
- Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical RecordPLOS ONE, 2015
- Using Default Options Within the Electronic Health Record to Increase the Prescribing of Generic-Equivalent MedicationsAnnals of Internal Medicine, 2014
- Harnessing the Power of Default Options to Improve Health CareThe New England Journal of Medicine, 2007