Health system pharmacists are playing a greater role in the decision-making process when it comes to the implementation of electronic health records in both hospital and ambulatory settings.

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Allie Woods, director, section of pharmacy informatics and technology at the American Society of Health System Pharmacy, told Healthcare IT News that the rapid evolution of electronic health information has enabled the adoption of safe medication practices, including pharmacist review of medication orders.

"Health-system pharmacists are contributing more to the health care team and playing a vital role in the management of patients’ health," said Woods. She added that in many locations, the pharmacists have become so integral to the decision-making processes that the team will not proceed without their presence.

[See also: Pharmacists rally for tougher e-prescribing rules]

Proponents of having pharmacists contribute more to technology decisions claim that as experts in the medication-use process, pharmacists offer an understanding of the complexity of managing patients’ medication regimens. "Pharmacists also provide a unique perspective to the design of health care IT products to facilitate the transfer of information," said ASHP's Woods.

In addition, Woods noted that the inclusion of the informatics pharmacist and the health-system pharmacy department improves efficiency and effectiveness of health care systems. In return, Woods said that the patients receive better outcomes from improved communication and decision-making processes.

But not everyone believes that pharmacists are contributing proportionately to the decision-making process when it comes to technology like EHRs.

A recent ASHP national survey of informatics pharmacists indicated that as few as 12 percent of informatics pharmacists were involved in the acquisition of health technology as compared to the 37 percent who were involved in pharmacy departmental technology procurements. The survey also indicated that informatics pharmacists were majorly involved in the build and maintenance of health technologies, repressively 48-69 percent and 76-87 percent, depending on the technology.

ASHP contends that there are significant challenges to overcome related to the pharmacists’ contribution to health care IT, including representation in the EHR. While many pharmacy informaticists are being included in the design and decision-making processes, it is often not in the beginning stages of the project. "The goal of seamless communication between the team members in various settings will require that the pharmacists are included in the design of new technologies even when the pharmacy aspects of the technology are not obvious to others" said Woods.

Advocacy around the need to include pharmacists in the decision-making process is a strategic priority to ASHP. ASHP is a founding and active member of the Pharmacy Health Information Technology Collaborative.

The e-HIT Collaborative’s mission is to assure the meaningful use of standardized electronic health records that supports safe, efficient, and effective medication use, continuity of care, and provide access to the patient-care services of pharmacists with other members of the interdisciplinary patient care team and to assure the pharmacist’s role of providing patient-care services are integrated into the National HIT interoperable framework.

A few years ago ASHP asked the Centers for Medicare & Medicaid Services to recognize the role of pharmacists in EHRs. Christopher Topoleski, Director, Federal Regulatory Affairs at ASHP said that to date, CMS has not directly responded to ASHP's request.

What specifically do health system pharmacists bring to the table in regard to contributing to the medical informatics decision-making process, in particular, EHRs?

According to ASHP, Pharmacy Informaticists are uniquely qualified to serve as liaisons between the pharmacy department and others involved in systems development, including vendors and other departments.

The pharmacy informaticist’s skills are needed to:

• Work closely with information systems and pharmacy staff to develop system programming requirements while understanding system capabilities and limitations,
• Develop and oversee databases related to medication management systems,
• Identify, suggest solutions to, and resolve system or application problems,
• Assess medication-use systems for vulnerabilities to medication errors and implement medication-error prevention strategies,
• Actively participate in the development, prioritization, and determination of core clinical decision-support systems, and
• Assist in mining, aggregating, analyzing, and interpreting data from clinical information systems to improve patient outcomes.

ASHP believes that depending on the size of the organization and its scope of medication services, one or more pharmacists assigned and responsible for pharmacy informatics may provide the best means for attaining the level of participation required for safe and effective information systems.

Jeff Chalmers, assistant director, pharmacy informatics at the Cleveland Clinic, asserted that while pharmacists are usually called upon to help design and implement the EHRs, CPOE, and e-prescribing systems, "they are not often at the table during the review and selection of these systems."

He feels as though pharmacists can be as valuable to assist in weighing the strengths and weaknesses of different systems before they are purchased in addition to being technical and clinical resources during the build and implementation phases.

"Many pharmacies today have a large amount of technology within the pharmacy itself," Chalmers said. During the purchase and installation of those pieces of technology, Chalmers asserted that pharmacists have often gained valuable experiences in a variety of areas, including working with vendors, project management, and go-live support that could be beneficial to a hospital or health system during the process of acquiring EHRs that have a broader scope than just pharmacy.

It's common for pharmacists to work on the design, building, and validation of EHR systems after they are purchased, Chalmers noted.

"I think pharmacists, specifically those with special training in informatics, are felt to be increasingly valuable as medications become more complex, and designing ordering processes around complex medications becomes increasingly challenging."

Chalmers said that these pharmacists are bridging a crucial gap between understanding clinical implications of ordering medications and understanding how to leverage the functionality of an EHR to make these processes more efficient, intuitive, cost effective, and ultimately safer.