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.