Preventing medication errors: EHRs and the pharmacist’s role

ONC says pharmacists at forefront of patient safety work

In many patient care settings, such as hospitals and clinics, pharmacists rely on access to electronic health records (EHRs) to review patients’ medication histories, identify drug interactions, confirm right dose–right drug combinations, and review other medication-related information. “When we get into safety, a big piece of pharmacy is the prevention of errors,” Shelly Spiro, BSPharm, FASCP, Executive Director of the Pharmacy HIT Collaborative, told Pharmacy Today.

According to a new brief issued in early September from the Office of the National Coordinator for Health Information Technology (ONC) in the U.S. Department of Health & Human Services, EHRs have improved patient safety and prevented medication errors. Results were based on data from the 2013 National Ambulatory Medical Care Physician Workflow Survey, which looked at responses from roughly 11,000 physicians who have adopted EHR systems. ONC said that about 70% of physicians answering the survey felt that their EHR alerted them to an important medication or laboratory test result, and three times as many physicians reported that their EHR prevented a potential medication error than caused one.

“Pharmacists and pharmacy systems have been at the forefront of patient safety work for years,” an ONC spokesperson wrote in an e-mail. “All high-reliability health care delivery systems demonstrating leadership in patient safety with best results have pharmacists tightly integrated into all aspects of delivery practice.” ONC attributed the results to computerized provider order entry (CPOE)and encouraged pharmacists to continue to be involved in CPOE and clinical decision support.

The case for e-prescribing

Objectives for electronic prescribing (e-prescribing) were established in the federal meaningful use EHR incentive program for early adopters of the technology who must show they are meaningfully using EHRs in order to receive financial payments. Although pharmacists weren’t directly included as eligible providers, the program has increased the adoption of e-prescribing in EHRs significantly by physicians and hospitals, according to ONC.

One of the top reasons for patient readmissions—which now cost hospitals under a penalty for Medicare patients in the Affordable Care Act—occurs when medications are improperly taken together. Since pharmacists can view a patient’s entire drug regimen, they are often the ones who can detect fatal drug interactions and other risks to patients.

As health systems fully realize meaningful use elements, experts say it will become even more important that key systems are integrated and work together correctly. “Pharmacists are in a pivotal role to ensure that all medication information is appropriately coded and clearly passed among systems,” Patricia Kienle, BSPharm, MPA, FASHP, Director of Accreditation and Medication Safety at Cardinal Health Innovative Delivery Solutions, told Today.

The Pharmacy HIT Collaborative has made inroads in laying the groundwork for pharmacists to become more integrated with EHRs—and when they do, for information to be exchanged in a standard way. In official policy on e-prescribing standards, APhA has called for the inclusion of pharmacists in quality improvement and meaningful use activities related to the use of e-prescribing and other health information technology that would positively affect patient health outcomes.

On the horizon

According to a 2013 American Society of Health-System Pharmacists National Survey on Informatics, Technology, and Automation, the use of e-prescribing has increased by 43% in hospitals that provide outpatient ambulatory care services. "As ambulatory e-prescribing becomes more prevalent, barriers that prevent full information being passed to entities outside a health system must be addressed,” said Kienle.

For instance, she says, after a patient is discharged from an academic medical center and goes home to his or her community pharmacy, that pharmacy may not be connected to the academic medical center. This builds the case further for the e-prescribing process to give pharmacies complete medication information to make sure the patient follows the proper medication regimen.

Pharmacists could also play a role in improving patient care through medication reconciliation, especially using a standardized framework of service delivery defined in the context of medication therapy management.

“Medication reconciliation becomes even more important when systems aren’t linked, since points at transitions of care are often where errors are initiated,” said Kienle.

Looking forward, the ONC said it will continue working with pharmacy groups on several suggestions to further prevent errors, starting with standardizing medication labeling.

“Pharmacists have always played a central role in drug safety, long before the first electronic health record, and there can be no hope of improvement without their continued leadership,” said the ONC spokesperson.