NINTH INTERNATIONAL CONFERENCE ON EMERGENCY MEDICINE

AUTHOR(S):               Tony Shannon MD; Craig Feied MD, FACEP, FAAEM; Mark Smith, MD, FACEP

                                  NationalCenter for Emergency Medicine Informatics, Washington, DC , USA

ADDRESS:                  2317 37^th Street, NW

                                    Washington, DC  20007

Title:  Wireless handheld computers can increase voluntary utilization of computerized prescription writing in the emergency department.

Introduction: Handwritten prescriptions contribute to a significant number of potentially avoidable medical errors. Computer-based prescribing systems are a potential solution because they provide a complete, legible prescription and can screen for known allergies, pertinent medical conditions, and drug-drug interactions. Physician acceptance of computer-based prescribing depends on many factors. We investigated the effect of mobile wireless handheld computers on voluntary utilization of an existing computer-based prescribing system within a busy urban emergency department in Washington, DC.

Objectives: Assess the effect of adding wireless mobile access to an existing computerized prescription-writing program.

Methods:  A prospective observational emergency department study. HTML-based wireless handheld computers with a prescription-writing interface were added to an existing clinical information system that already permitted (but did not require) computerized prescribing using a desktop PC. The numbers of handwritten and computer-generated prescriptions were recorded before and after introduction of the wireless mobile devices.

Results:  475 patients received 167 prescriptions during the study period. Before the introduction of handheld wireless devices, 59% of all prescriptions were computer-generated and the remainder were hand-written. After handheld computers were introduced, 73% of all prescriptions were computer-generated, and only 27% were handwritten. The fraction of prescriptions written using the pre-existing desktop PCs also increased after the introduction of a mobile prescribing device. Physicians who already used the desktop computer to write prescriptions were more likely to use the handheld device than were physicians who did not use the desktop computer.

Conclusion:  The availability of mobile hand-held devices increases voluntary physician adoption of computerized prescribing, and affects the use of both mobile and fixed-location prescribing programs. Increased utilization when mobile devices are available is principally due to increased utilization by physicians who already used non-mobile computerized prescribing programs.