JMIR Publications

ABSTRACT

Background:

The free-text note field of the NCPDP SCRIPT schema allows prescribers to communicate information which the schema does not otherwise accommodate. Including inappropriate (could be sent in a dedicated field) or unnecessary (provides no value to the prescription) notes has a negative impact on patient care, ranging from wasted clinician time to introducing error risk by including conflicting, or incorrect information.

Objective:

The research team hypothesized that appropriate usage of the notes field would improve using NCPDP SCRIPT version 2017071 (V2017071) in comparison to NCPDP SCRIPT version 10.6 (V10.6).

Methods:

As a follow up to the study “Analysis of Prescribers’ Notes in Electronic Prescriptions in Ambulatory Practice”, a qualitative analysis was performed on 5 000 randomly selected prescriptions for which the note field was populated. Notes were classified as appropriate, inappropriate, or unnecessary and then sub-categorized based on content. The team performed three analyses: 1) Comparing the original study to current results 2) Comparing current notes in V10.6 to V2017071, and 3) An updated evaluation of V2017071 notes with reclassified sub-categories.

Results:

No difference was found in the rate of inappropriate and unnecessary notes from the original study (71.45%) to the present-day sample (71.64%), nor when comparing current V10.6 (71.28%) to current V2017071 (72.00%). A 3.23% lower note population rate for V2017071 did reduce the normalized rate of inappropriate and unnecessary notes when comparing V10.6 (11.62%) to V2017071 (9.41%). Lastly, when reclassifying V2017071 sub-categories, the rate of inappropriate and unnecessary notes increased to 89.24%.

Conclusions:

For most prescriptions containing a note, the note is either inappropriate or unnecessary. This highlights a need to develop e-prescribing and pharmacy software to better utilize available schema elements and influence users to reduce the overall note population rate.