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EHR Use, CPOE System Use Common at Majority of US Hospitals

A recent study found 99 percent of hospitals engaged in EHR use and 96 percent of hospitals used CPOE systems with clinical decision support in 2016.

EHR Use

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By Kate Monica

- A study published in the September issue of the American Journal of Health-System Pharmacy (AJHSP) found 99 percent of surveyed hospitals participate in EHR use, while about 96 percent of hospitals use computerized prescriber order-entry (CPOE) systems with clinical decision support.

The national survey administered and analyzed by Pederson, et al. assessed responses from pharmacy directors at 392 general and children’s medical-surgical hospitals in the US. Respondents were asked about their EHR implementation and health IT use in 2016.

The survey sample was drawn from a hospital database at IMS Health.

Researchers evaluated how pharmacists used EHR systems and other health IT tools in 2016 to manage and improve medication use, particularly in relation to prescribing and transcribing practices.

Overall, researchers found hospitals are increasingly using EHR functionality to manage drug formularies and improve medication use.

“Pharmacists continue to expand their role in improving the prescribing of medications in both hospital and outpatient settings,” stated the report. “The adoption of EHRs and medication-use technologies has contributed to this growth.”

Specifically, 99.1 percent of respondents reported having partially or fully implemented EHR systems. CPOE systems with clinical decision support were reportedly in use at nearly 96 percent of hospitals, and about 93 percent of hospitals used barcode-assisted medication administration systems in 2016.

Additionally, researchers noted pharmacists were increasingly using EHRs to access medication histories during transitions of care between inpatient and outpatient settings in an effort to effectively improve care coordination.

About 75 percent of responding hospitals reported accessing medication histories during admissions to facilitate transitions of care, marking the method as the most frequently used way to improve care coordination in comparison to both medication counseling (45 percent) and discharge planning (36 percent).

While almost all hospitals have implemented EHR systems, the extent to which hospitals use the technology varies widely.

About 43 percent of hospitals in 2016 fully used EHR systems in place of paper records, while nearly 56 percent of hospitals engaged in partial EHR use with some daily clinical processes still requiring paper records.

Despite most hospitals still partially relying on paper records, EHR use has progressed significantly over the past 13 years. Since 2003, the percentage of hospitals using only paper health records has plummeted from 69 percent to 1 percent.

Additionally, pharmacy directors reported implementing a variety of EHR functionalities to improve hospital medication use. Researchers found about 75 percent of hospitals use a drug database for prescribers that exclusively includes formulary items.

CPOE use has also steadily increased over time.

About 50 percent of respondents reported using EHR functionalities to incorporate dose rounding and dose standardization into CPOE, as well as embed electronic prescription data into the CPOE process.

 “Over the past 13 years, the percentage of hospitals having CPOE systems has increased from 2.7 percent in 2003, with significant increases in the last 6 years,” wrote researchers.

CPOE has also become the most common way pharmacists receive medication orders, with about 91 percent of surveyed hospitals receiving orders electronically through CPOE.

“The use of CPOE to electronically transmit orders to the pharmacy has grown from 5.1 percent of hospitals in 2007 to 16.1 percent in 2010 and 69.8 percent in 2013,” noted researchers.

More than one-third of hospitals use their EHR systems to enforce formulary restrictions or communicate with other pharmacists for authorization during drug ordering. These hospitals also use EHR systems to allow entry of non-formulary medications by pharmacy and provide clinical decision support when ordering antibiotics.

“Less commonly implemented functionalities include communicating drug shortage information and alternatives, requiring a therapeutic purpose or indication as a safety check for most medication orders, and providing medication cost information to prescribers,” added researchers.

Larger hospitals reported using these functionalities more often than smaller facilities.

Overall, pharmacists at hospitals across the country are increasingly using EHR technology to improve care coordination and medication management.

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