Tip of the Week: EHRs and Quality Patient Care

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

A review of pharmacists’ use of advanced functionalities within EHR was published in the Journal of the American Medical Informatics Association. The authors recognized that pharmacists utilize EHR 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 various interventions. Barriers to using EHR include fear of litigation or criticism from other professionals, appropriateness of documentation, and time constraints.

Pharmacists can leverage 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 providers 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.

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 EHR 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 possible 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 medication therapy management and management functions can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. You or your institution can subscribe to AccessPharmacy to access the textbook.

Shane P. Desselle, RPh, PhD, FAPhA, is Professor of Social/Behavioral Pharmacy at Touro University California. He is author of Chapter 1: The “Management” in Medication Therapy Management and Management Functions in the textbook Pharmacy Management: Essentials for All Practice Settings, 5e.

REFERENCE

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