Exploring the Impact of the Prescription Automatic Screening System in Health Care Services: Quasi-Experiment.

Abstract

BackgroundHospitals have deployed various types of technologies to alleviate the problem of high medical costs. The cost of pharmaceuticals is one of the main drivers of medical costs. The Prescription Automatic Screening System (PASS) aims to monitor physicians’ prescribing behavior, which has the potential to decrease prescription errors and medical treatment costs. However, a substantial number of cases with unsatisfactory results related to the effects of PASS have been noted.ObjectiveThe objectives of this study were to systematically explore the imperative role of PASS on hospitals’ prescription errors and medical treatment costs and examine its contingency factors to clarify the various factors associated with the effective use of PASS.MethodsTo systematically examine the various effects of PASS, we adopted a quasi-experiment methodology by using a 2-year observation dataset from 2 hospitals in China. We then analyzed the data related to physicians’ prescriptions both before and after the deployment of PASS and eliminated influences from a variety of perplexing factors by utilizing a control hospital that did not use a PASS system. In total, 754 physicians were included in this experiment comprising 11,054 patients: 400 physicians in the treatment group and 354 physicians in the control group. This study was also preceded by a series of interviews, which were employed to identify moderators. Thereafter, we adopted propensity score matching integrated with difference-in-differences to isolate the effects of PASS.ResultsThe effects of PASS on prescription errors and medical treatment costs were all significant (error: 95% CI –0.40 to –0.11, P=.001; costs: 95% CI –0.75 to –0.12, P=.007). Pressure from organizational rules and workload decreased the effect of PASS on prescription errors (95% CI 0.18-0.39; P<.001) and medical treatment costs (95% CI 0.07-0.55; P=.01), respectively. We also suspected that other pressures (eg, clinical title and risk categories of illness) also impaired physicians’ attention to alerts from PASS. However, the effects of PASS did not change among physicians with a higher clinical title or when treating diseases demonstrating high risk. This may be attributed to the fact that these physicians will focus more on their patients in these situations, regardless of having access to an intelligent system.ConclusionsAlthough implementation of PASS decreases prescription errors and medical treatment costs, workload and organizational rules remain problematic, as they tend to impair the positive effects of auxiliary diagnosis systems on performance. This again highlights the importance of considering both technical and organizational issues to obtain the highest level of effectiveness when deploying information technology in hospitals.