ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2020
Suboptimal prescribing behaviour associated with clinical software design features: a retrospective cohort study in English NHS primary care.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed.
- Variation in duration of repeat prescriptions: a primary care cohort study in England.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- The impact of COVID-19 on medication reviews in English primary care. An OpenSAFELY-TPP analysis of 20 million adult electronic health records.British journal of clinical pharmacology · 2024Article
- OpenSAFELY: Representativeness of electronic health record platform OpenSAFELY-TPP data compared to the population of England.Wellcome open research · 2022Article
- Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient recordsThe British journal of general practice : the journal of the Royal College of General Practitioners · 2021Article
- Human Factors and Organizational Issues Section Synopsis IMIA Yearbook 2021.Yearbook of medical informatics · 2021Article
- Impact of Electronic Health Record Interface Design on Unsafe Prescribing of Ciclosporin, Tacrolimus, and Diltiazem: Cohort Study in English National Health Service Primary Care.Journal of medical Internet research · 2020Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundElectronic 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' are a 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.
aimTo describe time trends and practice factors associated with excess medication costs from ghost-branded generic prescribing. DESIGN AND
settingRetrospective cohort study of English GP prescribing data and EHR deployment data.
methodA 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.
resultsThere were 31.8 million ghost-branded generic items and £9.5 million excess cost in 2018, compared with 7.45 million ghost-branded generic items and £1.3 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.
conclusionA design choice in a commonly used EHR has led to £9.5 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.
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