ways of working through process change. However, it must be remembered that the accurate operation of systems requires accurate input from human operators too. The stock phrase about human error with computers, “garbage in, garbage out”
is apposite.
Systems have thus been described as a “ sociotechnical innovation ” [ 26 ] – meaning that they rely not just on computer hardware and technology, but the intui- tive input of human beings, as part of the total environment in which they operate.
With hospital electronic prescribing systems , it has been noted that the ability of systems to reduce medication errors relies not only on the operation of the software, but also the interaction of people with the software at the point of use. For this reason, system usability is important, and has been subject to considerable research using a variety of methods [ 27 ] . It is known from the experience with the Electronic Prescription Service (EPS) in England that end user systems can be compliant with the common assurance process (CAP) from a technical and functional perspective, but have problems with system usability when a person is put in front of the system.
One of the big debates in system design is whether systems should fi t around, and automate, existing processes, or whether working processes should be reverse- engineered to fi t an IT system. As a general rule, the former situation is preferable and makes introduction of IT easier. However, many systems are highly con fi gurable and the possibility exists for systems to be con fi gured to enable a new way of working, which would not have been possible without the ability of the system to automate and speed up monotonous and repetitive processes.
Nevertheless, if a system is con fi gured to support a new way of working, then proportionally more user training is required to ensure that the new working prac- tice is safe and ef fi cient.
Conclusion
The profession of pharmacy has traditionally been concerned with the preparation, dispensing and supply of medicines. However, during the last 30 years, due to the increasing complexity of modern medicines, the need to evaluate new medicines and wider changes in the health service, pharmaceutical industry and society in general, new professional roles have emerged for pharmacists. During this time, information technology has developed considerably and is able to support new roles and new ways of working for pharmacists. There is now the potential for IT systems to support the medicines use process and pharmacy professional activity in an inte- grated manner. However, an appropriate data, coding and classi fi cation infrastruc- ture for medicine and pharmacy concepts is essential to underpin this. There is also a need for convergence between a range of systems that historically have been designed and developed separately, in order to deliver integrated medicines man- agement services.
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Introduction
Healthcare professionals should maintain records of the patient care activities that they perform. While traditionally this has been a requirement from a medicolegal perspective, it is recognised that good record keeping supports evidence-based healthcare and facilitates audit and quality monitoring, which has become of increas- ing signi fi cance in many healthcare economies.
Over the last three decades, the use of patient medication record (PMR) systems by pharmacists in both hospitals and the community has become universal, and pharmacy professionals are familiar with the use of computerised records to support the dispensing process and provision of advice on medicines in their sphere of prac- tice. However, in both primary care and secondary care , new pharmacy services and innovative ways of working are being developed, which require real-time access to electronic medical records for clinical decision making.
Quality of care and cost bene fi t monitoring is a pressing need in large economies, where there are considerable public health needs, and where the healthcare system is insurance-based, such as the United States. In recent years, with the increasing use of information technology to support patient records , there has been a focus on standard data recording as a means of facilitating consistency of care across a range of professional settings.
Furthermore, an increasingly multi-disciplinary approach to healthcare demands the use of patient records that are shared between different healthcare professionals.
Electronic health record (EHR) systems enable this to happen.
However, electronic patient records contain sensitive, personal information about a patient’s medical conditions and treatment, and this information is used to make important treatment decisions. In addition, electronic records have the capacity to be disseminated or accessed from different locations. For these reasons, the security and accessibility of the record are important issues in the development and use of electronic patient records, as is the question of who can or should contribute to the record and how they are identi fi ed.
Chapter 2
Electronic Patient Records
This chapter will explore the development of electronic health records (EHRs) in general, discuss the legal and design issues with EHRs, and describe how EHRs are used in pharmacy practice and how they can support other systems, and enable new initiatives in the profession. It will discuss issues such as access and sharing EHRs, subject (patient) access to records , speci fi c record systems in the United States and United Kingdom, bene fi ts of EHRs and how they might support phar- maceutical care .