# Understanding CancelRx: Impact on Clinical Workflows, Medication Safety Risks, and Patient Outcomes

> **NIH AHRQ R21** · JOHNS HOPKINS UNIVERSITY · 2020 · $140,191

## Abstract

PROJECT SUMMARY
 Adverse drug events (ADE) are frequent in ambulatory care, leading to an estimated 4.5 million patient visits in
ambulatory care each year, and a substantial proportion of ADEs are preventable. Failure to communicate medication
discontinuations to patients’ pharmacies is a major contributing factor to these errors; an estimated 1.5 – 3% of
prescriptions are dispensed in error following discontinuation by a clinician. With over 1.7 billion e-prescriptions in
2017, this poses a major medication safety concern.
 The National Council for Prescription Drug Programs’ SCRIPT standard (version 10.6) supports the functionality to
send electronic prescriptions cancellations from electronic health records (EHRs) to pharmacies, known as CancelRx.
However, adoption of CancelRx has been limited, and its impact on patient outcomes and the workflows of key
stakeholders remains largely unknown. A growing literature recognizes the importance of shared technology to support
patient engagement and improve clinical outcomes and identifies the limitations of existing technology and
communication tools used in outpatient settings.
 The specific aims of this study are to:
  Develop strategies to optimize CancelRx implementation to support patients in medication management and
 identify where further health IT development is needed
  Measure the impact of CancelRx on patient outcomes, including dispensing errors and documented ADE
 following medication discontinuation
 We will evaluate the impact of electronic prescription cancellation in ambulatory care settings with diverse patients
with serious medical conditions and high risk medication use. We will use qualitative and human factors methods and
the lens of the patient work system model to identify patient needs and remaining gaps in communication and care
coordination following CancelRx implementation. We will then engage clinical and industry stakeholders in the process
of human centered design to prototype solutions which can be implemented locally and shared with other
organizations. Finally, we will use EHR and pharmacy data to identify dispense-after-discontinuation medication errors
and ADE and conduct an interrupted time series analysis to determine the impact of CancelRx implementation on these
outcomes.
 Key anticipated scientific contributions of this research include an understanding of the impact of CancelRx on
patient medication management processes and outcomes, including dispensing errors, development of strategies to
improve CancelRx implementation that could be disseminated to other health care settings, engagement of industry
leaders in the identification of desirable health IT features, and validation of a measurement strategy for CancelRx
evaluation in other settings and with community partners.

## Key facts

- **NIH application ID:** 10018011
- **Project number:** 5R21HS026584-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Samantha Pitts
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $140,191
- **Award type:** 5
- **Project period:** 2019-09-15 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10018011

## Citation

> US National Institutes of Health, RePORTER application 10018011, Understanding CancelRx: Impact on Clinical Workflows, Medication Safety Risks, and Patient Outcomes (5R21HS026584-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10018011. Licensed CC0.

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