How to Survive an EMR Conversion

To ensure accuracy in its electronic medical record (EMR) system, a hospital relies on the precision of the inpatient formulary, order sentences, medication frequencies, and other important deliverables. To help minimize the stress that comes with a new EMR implementation, I would like to share some lessons I’ve learned from a current conversion.

1. Develop a pharmacy EMR conversion team or task force.

This team or task force must be equipped with an informatics specialist who is responsible for maintaining the formulary, order sentences, frequencies, and any other medication management decisions. It should also consist of a pharmacist for clinical decision making, a front-line user, and if possible, a pharmacy technician for dispensing cabinet and reporting compliance.

2. Maintain a formulary.

When developing the formulary for a new EMR, eliminating as many items as possible will minimize headaches during conversion. Analyze use of the current formulary, and with pharmacy and therapeutics committee’s approval, eliminate any medications with minimal prescribing.

3. Verify medication frequencies with nursing staff.

When transitioning to a new version of an existing EMR, confirm that frequencies in the updated EMR are consistent and used with the same frequencies currently being employed. When implementing a brand-new EMR, discuss dosing times with nursing staff to ensure that no changes need to be made.

4. Confirm synonyms, order sentences, and pre-built order sets.

Work with your pharmacy EMR conversion team to determine whether new synonyms, order sentences, and pre-built order sets will need to be built. Consider whether they are for pharmacy use only or available for all computerized physician order entry (CPOE).

This is a good time to clean up synonyms and sentences that are not currently being used or not appropriate for specific items (eg, chemotherapy order sets built for pharmacy ordering only).

5. Confirm reporting tools.

When transitioning to a new EMR, reporting capability should be similar, but you should ensure that the available reports are designed to emulate the same ability as your current configuration.

Some reports to consider include:

• Admission records for counseling and medication reconciliation statistics
• Barcode scanning percentages (if scanning occurs at bedside)
• Total doses administered
• Medication errors and near-miss incidents
• Dispensing cabinet reports Reconciliation (doses dispensed vs. charted doses) Discrepancies Witness pairing summaries used for nursing administration and wasting of narcotics Inventory reports Overrides

6. Acknowledge workarounds and attempt to alleviate them.

The purpose of an EMR is to save time and simplify processes, right? So, consider things that make your current life difficult and present them to those in nursing, respiratory, therapies, lab, and anyone else who may encounter medication orders.

Just because a workflow is “working” for you now doesn’t mean that it is the best, simplest, and most convenient method moving forward. If the new workflow is awkward, timely, or problematic, discuss it with your EMR team to determine whether there is a better way to accomplish the same task through less clicks, steps, or maneuvers within the new system.

7. Test it out.

When testing an EMR for pharmacy, be on the lookout for items that are off the beaten path. Think about items in your current system that seem to give you issues, and keep those on your radar.

Some notorious EMR-related pharmacy issues reside in:

• Multi-dose vial charging
• Oncology/chemo charging (if billing for waste)
• IV and order sets (both CPOE and pharmacy only)
• Barcode scanning to ensure barcode medication administration with nursing is configured properly
• Configuration of dispensing cabinet
• Dual authentication (when required)
• Auto-verification of emergency medications (when permitted)
• Charging of pharmacy items on administration or dispense

Each EMR has advantages and disadvantages, but the ultimate success of the pharmacy relies upon the EMR team to be proactive in completing deliverables and maintaining deadlines.

My own team eliminated 65 items from the formulary by running usage reports and allowing pharmacy technicians to pull minimally used medications each month. All of these items were processed through pharmacy and therapeutics committee meetings.

Nursing super-user training is essential for buy-in during the process of both new and existing EMR conversion. Both pharmacists and technicians should be trained on cabinet usage to assist nursing staff when needed.

In my hospital, frequencies were discussed at nursing meetings to confirm that all currently used frequencies were consistent with what is being administered. This discussion led to changing frequencies to those which better suited nursing administration times to coordinate with cabinet dispensing. It was also important to the nursing staff to ensure that certain specific times of ordering would remain intact within the new EMR.

Reference

ASHP Section of Pharmacy Informatics and Technology. ASHP guidelines on pharmacy planning for implementation of computerized provider-order-entry systems in hospitals and health systems. Am J Health Syst Pharm. 2011 Mar 15;68(6):e9-31. doi: 10.2146/sp100011e.