into the EHR from outside sources such as retail pharmacies. Reviewing the external medication history can help with the quality
of the information entered into the EHR in cases where the patient may not know the exact name of the medications they take.
Workflow and Management of EHR Pharmacy Data
A new medication goes through multiple steps before it becomes useful in the EHR system. It involves the processes of
decision-making, data entry, clinical decision support, and verifications (see Figure 1 on page 41).
Medication orders can be either given in the physician’s office
or in the hospital, or filled at a retail pharmacy. Once the patient
has seen the provider, new medication orders might be entered
into the EHR system for medications to be given while the patient is in the office.
Providers enter the medication order by checking the information from pre-built lists in EHR databases. This information includes the medication name, dosing information, unit
of measure, frequency, route of administration, duration information, and refill information (if it is a prescription order).
The maintenance and updates of these databases is normally
done by systems analysts. The documentation of the medication administration can be entered into the system manually or
through a barcode scanning process where the National Drug
Code (NDC) is checked in the system.
The medication order then flows through the EHR into the clinical decision support process. In order to help prevent a medication error from occurring, allergy checking, drug interaction
checking, and duplicate therapy checking are completed. The
data required to support the clinical decision support checking is
maintained in the system databases by the systems analysts.
For the purpose of ensuring patient safety and preventing delays in patient care, alerts are built into the EHR by the system
analysts. Examples of the alerts include result checking, where
the EHR checks lab values when ordering medications in order
to ensure the medication is appropriate and safe, dose range
checking when an order outside of the maximum range occurs
based upon defined criteria such as patient age or weight, and
drug availability alerts for notifying the provider that the ordered medication may not be available from the pharmacy.
The prescription order can be sent electronically (e-prescribing)
to a pharmacy directly from the point of care. Available pharmacies, insurance formulary information, and patient medication
updates are maintained in the EHR system. E-prescribing is replacing handwritten pharmacy orders to improve data accuracy,
increase patient safety, and increase quality of care.
Challenges of Managing EHR Pharmacy Data
Maintaining quality and pertinent pharmacy data are often
challenged by many factors, such as skilled personnel needed,
time constraints, regulation compliance, and protecting confidentiality of patient health information.
Making sure the pharmacy data are up to date and maintained
has its challenges. Keeping the pharmacy knowledge database
updated requires skilled staff like pharmacists and pharmacy technicians as well as non-pharmacy personnel such as data analysts.
The pharmacy staff are ensuring that newly added information to
the database is correct and relevant for the practice. Once the pharmacy staff has validated this block of information, the data analyst
is given permission to bring in the updated pharmacy information
to the database. This process requires personnel with a high-level
working knowledge of both pharmacies and systems.
The aforementioned process can also be very time-consuming. Due to the rapid changes in critical drug information (
drug-drug interactions, drug-allergy alerts, etc.), it is essential to keep
the pharmacy database up to date. After validation, these data
are usually, without exception, placed in a testing environment
for pharmacy staff to test its effect on the system. This can reveal
defects within the information or validate its usability. If defects
are detected during testing, the information must be augmented
or withdrawn to ensure no ill effects on system stability. If no defects are seen during testing, the information can then be placed
into an active working environment (sometimes called production). The process of moving this information from the research
phase to the active working environment can take weeks, and
by then sometimes new information is already available to be
imported—therefore, this is an iterative process.
This pharmacy information is regulated by the US Food and
Drug Administration (FDA), a branch of the US Department of
Health and Human Services. The FDA provides guidance and
regulations on the usability of pharmacy information within
the EHR. This is usually the responsibility of the EHR vendor to
ensure these regulations are being followed, but it would serve
users well to verify with the EHR provider to ensure compliance.
Due to the electronic nature of EHRs and the fact that more
information is available online than ever before, maintaining
patient information confidentiality and securing the pharmacy
database is also a challenge.
EHR pharmacy data are growing constantly and are never static
except when a user chooses to make use of it at a specific point. It
is essential that all health information management and provider
professionals involved in the process consider this to be a living
database, and regularly make contributions to sustaining it. ¢
Shannon H. Houser ( email@example.com) is an associate professor, Department of Health Services Administration/Health Informatics Program,
Jodie Wagner ( firstname.lastname@example.org) is a MSHI graduate student and clinical systems analyst III, and Christopher O. Holland (cholland@uabmc.
edu) is a MSHI graduate student and systems analysts III at the University
of Alabama at Birmingham.
Quiz ID: Q1939006 | EXPIRATION DATE: JUNE 1, 2020
HIM Domain Area: Clinical Data Management
Article—“Managing and Analyzing EHR Pharmacy Data in the
Review Quiz Questions and Take the Quiz Based on
this Article Online at https://my.ahima.org/store
Note: AHIMA CE quizzes have moved to an online-only format.