Electronic Health Records (EHRs) and Quality Patient Care

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Pharmacists and other health professionals have increasingly available at their disposal patient electronic health records (EHRs) that are portable or can be shared owing to the interoperability capabilities of computer/information systems across multiple providers. The adoption of EHRs has impacted the methods by which these professionals care for their patients.

Nelson et al reviewed pharmacists’ use of advanced functionality with the EHR.1 The authors recognize that pharmacists utilize EHRs for 3 main roles: documentation, medication reconciliation, and patient evaluation and monitoring. Documentation tasks include medication reconciliation notes, allergy documentation, notes on medication therapy, proactive recommendations, and interventions of various types. Barriers to their doing so include fear of litigation or criticism from other professionals, appropriateness of documentation, and time constraints. Pharmacists use the EHR to compare and contrast medication lists, link medications to patient problems, and evaluate effectiveness and adverse drug events. Unfortunately, even while interoperability has improved, there is still a serious disconnect between hospital, retail community pharmacies, and other enterprises regarding patient data, which thus attenuates effectiveness of care and patient safety efforts. There are also relatively few studies on the information needs and information-seeking behaviors of pharmacists. The authors state further that there appears to be a misunderstanding of what informatics is in the pharmacy world and that pharmacy informatics education is lagging behind current practice and is inconsistent across the nation. The EHR should allow for opportunities to support pharmacists’ cognitive tasks and workflows. Unfortunately, clinical decision support tools for pharmacists remain understudied and underutilized. The authors of the paper recommend that pharmacists’ workflow and information needs are met within EHRs to optimize medication therapy quality and outcomes.

Pharmacy managers might have little control over existing and emerging technology. However, they can have significant input into the needs for pharmacists and staff enabling them to operate with greatest effectiveness and efficiency. They have to proffer such needs in capital budget requests and also be at the table when negotiating institutional operating systems and designing workflow around current and emerging technology. Additionally, they can have a say in appropriate vendor selection for EHR and other information technology needs, given that there is often wide variation in the quality and support services provided by these vendors.

Additional information about Managing Medication Use Process Supporting Technologies and Automation and Strategic Planning in Pharmacy Operations can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Nelson SD, Poikonen J, Reese T, et al. The pharmacist and the EHR. J Am Med Infor Asoc. 2017;24:193-197.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California