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Invited Commentary
April 2016

Free-Text Notes as a Marker of Needed Improvements in Electronic Prescribing

Author Affiliations
  • 1Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Medicine, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2016;176(4):471-472. doi:10.1001/jamainternmed.2015.8562

In this issue of JAMA Internal Medicine, Dhavle and colleagues1 present the results of a study indicating that, of the 14.9% of electronic prescriptions with free-text notes, 66.1% contained inappropriate content for which a structured data field (ie, a field intended for certain specific pieces of information, such as days’ supply or indication for a medication) exists in the most commonly used national e-prescribing standard. Most concerning, almost 1 in 5 (19.0%) of these inappropriate notes contained conflicting medication directions from the structured fields intended for this purpose. Of the notes with appropriate content, almost half (47.3%) contained information that could be communicated using structured fields approved in a version of the e-prescribing standard that has yet to be implemented. An additional 9.6% were prescription cancellation requests for which a separate e-prescribing message exists but is not widely supported in most currently available e-prescribing software.