ArticleJournal of medical Internet research2020
Impact of Electronic Health Record Interface Design on Unsafe Prescribing of Ciclosporin, Tacrolimus, and Diltiazem: Cohort Study in English National Health Service Primary Care.
Article in Journal of medical Internet research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- For the record: a narrative review of ambient voice technology in clinical documentation for dentistry and wider healthcare.British dental journal · 2026Review
- 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
- Pharmaceutical Analysis of Inpatient Prescriptions: Systematic Observation of Hospital Pharmacists' Practices in the Early User-Centered Design Phase.JMIR human factors · 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
- Barriers and Opportunities for the Use of Digital Tools in Medicines Optimization Across the Interfaces of Care: Stakeholder Interviews in the United Kingdom.JMIR medical informatics · 2023Article
- Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: A federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY.Thrombosis research · 2022Article
- OpenSAFELY: Representativeness of electronic health record platform OpenSAFELY-TPP data compared to the population of England.Wellcome open research · 2022Article
- The Relationship Between Electronic Health Record System and Performance on Quality Measures in the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) Registry: Observational Study.JMIR medical informatics · 2021Article
- 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
- Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundIn England, national safety guidance recommends that ciclosporin, tacrolimus, and diltiazem are prescribed by brand name due to their narrow therapeutic windows and, in the case of tacrolimus, to reduce the chance of organ transplantation rejection. Various small studies have shown that changes to electronic health record (EHR) system interfaces can affect prescribing choices.
objectiveOur objectives were to assess variation by EHR systems in breach of safety guidance around prescribing of ciclosporin, tacrolimus, and diltiazem, and to conduct user-interface research into the causes of such breaches.
methodsWe carried out a retrospective cohort study using prescribing data in English primary care. Participants were English general practices and their respective EHR systems. The main outcome measures were (1) the variation in ratio of safety breaches to adherent prescribing in all practices and (2) the description of observations of EHR system usage.
resultsA total of 2,575,411 prescriptions were issued in 2018 for ciclosporin, tacrolimus, and diltiazem (over 60 mg); of these, 316,119 prescriptions breached NHS guidance (12.27%). Breaches were most common among users of the EMIS EHR system (breaches in 18.81% of ciclosporin and tacrolimus prescriptions and in 17.99% of diltiazem prescriptions), but breaches were observed in all EHR systems.
conclusionsDesign choices in EHR systems strongly influence safe prescribing of ciclosporin, tacrolimus, and diltiazem, and breaches are prevalent in general practices in England. We recommend that all EHR vendors review their systems to increase safe prescribing of these medicines in line with national guidance. Almost all clinical practice is now mediated through an EHR system; further quantitative research into the effect of EHR system design on clinical practice is long overdue.
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