EMR innovation: Implementing pharmacy workflows across a multihospital health system

Health-System Edition

Clinical informatics pharmacist Dan Persells, PharmD, and his team faced a lofty challenge: modify Aurora Health Care’s existing electronic medical record (EMR) system to accommodate pharmacy department workflows designed to improve communication among hospital pharmacists and increase patient care.

Customization equals innovation

“The EMR has a lot of tools available, but how you use them is specific to each organization,” said Persells. “One of the tricks to using the EMR to accommodate pharmacy workflow requests is to find ways to use each tool in a novel way.”

Aurora Health Care comprises 15 hospitals and more than 150 clinics in Wisconsin. About 5 years ago, the health system switched EMR vendors and implemented that system across all of its hospitals and clinics. The process took about 3 years. 

“At that point, the pharmacy department started to come up with workflows, goals, and department strategic goals that were [tied to] the pharmacy workflow and the medical record,” explained Persells in an interview with Pharmacy Today. It was up to Persells and the information technology (IT) team to make this a reality.

Persells is one of six clinical pharmacists on the IT team. Although Persells and the pharmacists spend most of their time working on informatics projects, they each spend about 10% of their time staffing Aurora’s hospitals in clinical pharmacy roles in the inpatient setting. This helps the pharmacists on the IT team better understand how pharmacists use the EMR in everyday workflows.

Monitoring tool

One of the first projects Persells and his team tackled was developing a tool that would allow pharmacists to closely monitor patients taking certain medications, such as anticoagulants, anti-infectives, and other high-risk medications.

“We focused on displaying information about those medications in one concise area of the EMR,” said Persells. “For an anticoagulant, the [tool] shows things like a patient’s INR [international normalized ratio], PTT [partial thromboplastin time], hemoglobin, and more. The goal was to make the monitoring more efficient so [a pharmacist] doesn’t have to hunt through the patient’s chart to get that information.”

According to Persells, the time savings achieved in patient monitoring resulted in more time for pharmacists to dedicate to other patient care activities.

Admission/discharge navigators

A recent initiative at Aurora has been incorporating pharmacists into the admission and discharge medication reconciliation process. “We created several ‘navigators’ that include all of the information in one area [of the EMR] that is useful to a pharmacist during each of those processes,” said Persells. 

Timing and efficiency are everything

“The trick was figuring out when pharmacists would perform different tasks and how to do them in a timely fashion,” said Persells. “We didn’t want to hold up discharges by taking too much time after a provider performed medication reconciliation.” The same was true for the admission process. “We had to make sure we were addressing admission medication reconciliation issues quickly,” he added.

To keep all of the information organized, pharmacists use patient lists in the EMR. The team created patient list columns to track admission medication reconciliation review status, discharge medication reconciliation review status, warfarin, and heart failure education for each patient. “We used icons in each of the columns to show the status for each patient,” said Persells. “A stop sign if the task needs to be completed, a yield sign if it is in process, and a check mark if it has been completed.”

Pharmacists can look at the columns as often as needed to see what is happening with their patients in real time. 

Advice for creating tools

According to Persells, having good communication between the IT team and the pharmacists is very important. “It’s helpful to have the IT team involved early on in the initial workflow proposals and when generating ideas to help identify what the medical record can and can’t do for you,” he said. “It allows you to implement changes in the EMR quicker and better support pharmacy workflows.”