Communication through the electronic health record: Frequency and implications of free text orders

Swaminathan Kandaswamy, Aaron Z. Hettinger, Daniel J. Hoffman, Raj M. Ratwani, Jenna Marquard

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Communication for non-medication order (CNMO) is a type of free text communication order providers use for asynchronous communication about patient care. The objective of this study was to understand the extent to which non-medication orders are being used for medication-related communication. We analyzed a sample of 26 524 CNMOs placed in 6 hospitals. A total of 42% of non-medication orders contained medication information. There was large variation in the usage of CNMOs across hospitals, provider settings, and provider types. The use of CNMOs for communicating medication-related information may result in delayed or missed medications, receiving medications that should have been discontinued, or important clinical decision being made based on inaccurate information. Future studies should quantify the implications of these data entry patterns on actual medication error rates and resultant safety issues.

Original languageEnglish (US)
Pages (from-to)154-159
Number of pages6
JournalJAMIA Open
Issue number2
StatePublished - Jul 1 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association.


  • Communication
  • Electronic health record
  • Safety
  • Workaround


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