ArticleApplied clinical informatics2019
Understanding CancelRx: Results of End-to-End Functional Testing, Proactive Risk Assessment, and Pilot Implementation.
Article in Applied clinical informatics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Ambulatory Medication Change Workflows' Effect on Communication to Pharmacies.Applied clinical informatics · 2025Article
- Patient Information Needs During Ambulatory Medication Changes: A Qualitative Study.Journal of patient-centered research and reviews · 2025Article
- Human Factors and Organizational Issues in Health Informatics: Review of Recent Developments and Advances.Yearbook of medical informatics · 2024Review
- Understanding the Information Needs of Pharmacy Staff Using CancelRx: A Qualitative Study of the Use of PrescriptionExploratory research in clinical and social pharmacy · 2024Article
- From MedWreck to MedRec: A Call to Action to Improve Medication Reconciliation.Applied clinical informatics · 2024Article
- CancelRx case study: implications for clinic and community pharmacy work systems.BMC health services research · 2023Article
- Discontinuation of outpatient medications: implications for electronic messaging to pharmacies using CancelRx.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- CancelRx implementation: Observed changes to medication discontinuation workflows over time.Exploratory research in clinical and social pharmacy · 2022Article
- Impact of CancelRx on discontinuation of controlled substance prescriptions: an interrupted time series analysis.BMC medical informatics and decision making · 2022Article
- CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Clinician Perceptions on the Use of Free-Text Communication Orders.Applied clinical informatics · 2021Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCancelRx allows prescribers to send electronic cancellation messages to pharmacies when medications are discontinued. Little is known about its functionality and impact on clinical workflows.
objectivesTo understand CancelRx functionality, its potential impact on workflows and medication safety risks, and to develop mitigating strategies for risks introduced by implementation.
methodsWe conducted direct observations and semi-structured interviews to develop CancelRx use cases and assessed CancelRx in an end-to-end test environment, proactive risk assessment, and pilot implementation from April 16 to July 15, 2018.
resultsE-cancellations were sent upon discontinuation of e-prescriptions written within the electronic health record (EHR), but not other medications (e.g., printed prescriptions) and could be initiated by nonprescribers. In our proactive risk assessment, CancelRx implementation eliminated five of seven failure modes in outpatient prescribing to Johns Hopkins pharmacies, but introduced new risks, including (1) failure to act if an e-cancellation was not sent or was unsuccessful; (2) failure to cancel all prescriptions for a medication; (3) errors in manual matching; and (4) erroneous medication cancellations. We identified potential mitigation strategies for these risks. During pilot implementation, 92.4% (428/463) of e-cancellations had confirmed approval by the receiving pharmacy, while 4.5% (21/463) were denied, and 3.0% (14/463) had no e-cancellation response. Among e-cancellations received by the pilot pharmacy, 1.7% (7/408) required manual matching by pharmacy staff. Based on performance in testing, 73.4% (340/463) of completed e-cancellations would be expected to generate an in-basket message, including 21 (6.2%) denials and 319/340 (93.8%) approvals with a note from the pharmacy.
conclusionCancelRx is an important functionality with the potential to decrease adverse events due to medication errors. However, changes in implementation in our EHR and pharmacy software and enhancements in the CancelRx standard are needed to maximize safety and usability. Further studies are needed to evaluate the impact of e-cancellation on medication safety.
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