There are high expectations as the advantages of the Electronic Patient Record (EPR) to prescribing research. The automatic collection of data that currently has to be laboriously obtained from paper records seems to herald a new era for research. However, there is debate as whether research will really be easier with the EPR, or just difficult in a different way¹. This study aims to explore the differences between using two sources of pharmacists' prescribing modification data (the EPR and self-report), from the perspective of ease of analysis and interpretation and completeness of data collection.

In a large teaching hospital, an EPR had been in place since 2000, with electronic prescribing of discharge medication since May 2001. An extract of all prescribing data from May 2001 to July 2002 was taken and the Access database was analysed to explore the pharmacists' prescribing interventions, using BusinessObjects® (a query and analysis tool used to interrogate relational database). Data on pharmacists' routinely collected interventions for discharge prescriptions for a week each in January and May 2002 were categorised by intervention type. More detailed analysis of the electronic data for these two weeks was conducted and compared with the self-reported data.

In the full database, there were 67440 inpatient or outpatient visits to the hospital, for 37380 patients, 1.64 (±1.65 SD) visits per person. Of these, 7145 patients had been prescribed 62640 discharge medications, during 8972 admissions; 54907 of these prescriptions were by doctors, 7623 by pharmacists and the remainder by other health care professionals. There were 2992 changes to prescriptions recorded; most were altered by pharmacists (2156, 72.0%) rather than doctors (452, 15.1%). However, it was also noted that 3782 drugs had been stopped within one day of being prescribed, mostly by pharmacists (2679, 70.8%). Review suggested that many represented treatment modifications, where one drug or preparation had been stopped and immediately replaced with another. However, these data could only be identified manually, by visually comparing start and stop dates. Therefore, this in-depth analysis was conducted only for the two weeks where intervention data also existed. During this time, there were 2857 drugs prescribed and the pharmacists made 494 modifications to 466 drugs that could be identified from the EPR; 104 modifications to 103 drugs were recorded in the intervention data. As data were anonymised, the degree of overlap could not be ascertained.

These data confirm previous findings that self-reported interventions provide a considerable underestimate of work done by pharmacists. However, the reports were easy to use, as the required information was in an accessible format. The EPR data were more comprehensive, but there were unexpected difficulties in extracting prescribing modification data that were not linked to a single order. EPR data are created in a particular context, to facilitate patient care. The secondary analysis of such data for research purposes may involve considerable manipulation and associated time, which should not be underestimated¹.

References

1 Berg M, Goorman E. The contextual nature of medical information. Int J Med Inf 1999; 56:51-60