This article about confusion in the filling of e-prescriptions by pharmacists caught my attention (see: Errors, Confusion Common in Notes Field in e-Prescriptions). Below is an excerpt from it:
The free-text Notes field in electronic prescriptions frequently contains information that should be conveyed in other existing standard data fields, and leads to confusion or errors, according to a retrospective, qualitative study published online...in JAMA Internal Medicine. Other data from the notes field present an opportunity to develop additional fields in e-prescription messages to reduce confusion....The optional, 210-character, free-text Notes field available in the e-prescription message is a well-documented source of potential miscommunication between prescribers and pharmacists....This field is intended to allow prescribers the option of including additional patient-specific information that is relevant to the prescription but for which a dedicated field does not exist in the currently implemented version of the SCRIPT standard (version 10.6)....[S]ome potential reasons for inappropriately used free-text notes include restrictive or difficult electronic health record systems, insufficient user training, or the 140-character limit in the Patient Direction...field....Vague, ambiguous, or conflicting patient directions in the Notes field are...disruptive to pharmacy workflow and can result in dispensing errors if unnoticed, ignored, or misinterpreted by pharmacy staff.
No one should be surprised that a free text field in an e-prescription has been a source of confusion to the pharmacists filling the prescriptions. What is surprising is that such a field was even available in the first place in e-prescriptions. Perhaps the designers of the e-forms wanted to give physicians as much latitude as possible when completing such forms. Many physicians get frustrated with the rigidity of fixed fields in EHRs and other medical applications but structured content is far preferable in e-forms (see: Structuring for the Future of Clinical Decision Support (CDS)):
....[T[here are two approaches to content when designing point-of-care IT infrastructures—structured and unstructured. While both have the potential to standardize care and improve decision-making, industry preference leans toward greater integration and use of structured content for its ability to lay a foundation of improved accuracy, efficiency and ability to drive clinical decision support and analytics. Because structured content is tagged or coded data that resides in a fixed field, it can be easily located, identified and understood, simplifying the process of integrating content into existing systems and sharing between disparate systems. In contrast, unstructured content, such as free text, often results in irregularities and ambiguities that make it harder to interpret.
I suspect that one of the major reasons that a free-text field was allowed in e-prescriptions was that it was assumed that pharmacists would be able to understand and interpret the physician entries. However, the conclusion in the article cited above that the interpretation of the information in such fields was often challenging for the pharmacists and disruptive of workflow probably should have been anticipated.