Generic medication prescription rates after health system-wide redesign of default options within the electronic health record

The growing adoption of the electronic health record (EHR) brings new opportunities to improve physician decision making toward higher-value care.¹ Default options, or the conditions that are set into place unless an alternative is actively chosen, have been shown to influence decisions in many contexts.² However, the effectiveness of different ways of implementing defaults has not been systematically examined in health care, and many people may assume that changing defaults is a one size fits all intervention that will always have the same effect.² In prior work, changing the design of EHR medication display defaults for internal medicine physicians increased generic prescribing rates by 5.4 percentage points.³ In that intervention, the process of searching for a brand-name medication changed from displaying a list of brand-name options followed by their generic equivalents to displaying only generic-equivalent options. To view brand names, a physician had to click on another tab. In November 2014, the University of Pennsylvania Health System implemented a different change in EHR defaults among all specialties across the entire health system. Instead of changing EHR display defaults, an opt-out checkbox labeled “dispense as written” was added to the prescription screen, and if left unchecked the generic-equivalent medication was prescribed. The objective of this study was to evaluate the effect of this intervention on physician prescribing behaviors.

National Institute on Aging