An electronic health record (EHR) refers to a systemized collection of information stored in a digital format to improve the functionality of a health care facility (French et al., 2018). The focus of this project was to examine how the use of EPIC EHR, specifically in the pharmacy module, would ensure the lot and expiration date associated with different drugs match. Matching the lot and expiration would mean that the alerts that end users receive when using the system would reduce significantly. A majority of the alerts that the end-users receive are not meaning, which means that most of the users find it rather challenging using the system as part of their everyday activities. The project was intended to find an alternate approach through which to maximize usage of EPIC EHR with the view that this would ensure the alerts achieve their intended objectives. The goal of matching drug lot and expiration is to reduce cognitive overload, as the alerts that users receive will be much more meaningful.
Background
EPIC is a cloud-based electronic health record (EHR) used in healthcare settings to aid in advancing patient engagement and the facilitation of remote care (Wang & Song, 2018). The use of this system is especially important in drug dispensation, as it helps in ensuring that only drugs necessary for patient care are dispensed at any given time. However, EPIC introduced a usability problem affecting its effectiveness. The problem results from instances where the lot and expiration of drugs scanned using the system do not match. In case of a mismatch in the lot and expiration, an alert pops up as a notification for the user. An increase in such notifications has had notable implications on areas such as productivity of the employees working in the pharmacy. Additionally, the alerts also contribute to a backlog in the workflow, considering that it becomes much harder for employees to deliver on their set out responsibilities.
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The alerts have also contributed to decreased enjoyability for the end-user when using the system as part of dispensing medication. Ash & Bates (2005) highlight the importance of ensuring proper functionality of an EHR system with the view being that this will play a critical role in advancing motivation among health workers to use the system as per expectation. In this case, the challenge that the pharmacy is facing is that the employees encounter a lot of alerts that affect their motivation to use the system, considering that it slows them down significantly. The proposed usability solution to help deal with the issues noted is the need to change the system in a way that would only alert users in cases where the scanned lot and expiration are different than what is already recorded. The alerts that would be generated from the change would be much more meaningful to the end-use; thus, decreasing cognitive load.
Scope
The number of drugs dispensed from the pharmacy is notably high, considering the number of patients that the health facility handles at any given time. The shift towards using an EHR was expected to health streamline service delivery for the pharmacy, as it would make it much easier to dispense drugs in a much more efficient way. However, this has not been the case, as the use of EPIC EHR has introduced technical dynamics affecting the performance of its pharmacy module. One of the most notable challenges that the system introduces is regular screen pop-ups, which require a technician to verify that the lot and expiration match. That becomes a key issue considering the high volume of drugs being dispensed from the pharmacy, which increases the number of pop-ups.
Improved user experience is a key benefit associated with the usage of EHR compared to the use of other data collection and storage methods in health care settings (Rinner, Sauter, Endel, Heinze, Thurner, Klimek, & Duftschmid, 2016). However, the staff working in the pharmacy did not see this benefit when using the EPIC EHR, as the pop-up alerts contributed to cognitive overload. The consequence of such overload is that the productivity of these staff members reduced significantly; thus, causing a significant backlog in dispensing drugs through the system. Most of the workers did not have the technical knowledge that would allow them to verify the lot and expiration of drugs as per requirements in the alerts. Most of these end-users found themselves lacking enjoyment in the use of the EPIC EHR, as it was somewhat challenging for them to reduce the number of alerts through verification. Therefore, this affected the efficiency of the system as part of its projected ability to increase performance capacities for the pharmacy.
Key Metrics
The proposed change in the system was focused on ensuring that it was able to recognize the same lot and expiration without any major challenges with the alerts arising from instances where the lot and expiration are different based on the records stored on the system. The intended use of the proposed change was to eliminate the need for alerts that users receive in cases where a specific drug or medication is scanned multiple times. It means that regardless of the number of times that a drug is scanned, the end-user does not receive any alerts for purposes of verification, as this would serve as a major challenge. The goal was to streamline the scanning of medication when using the EPIC EHR system, which would help improving workflow; thus, increasing productivity for the workers in the pharmacy.
The increase in alerts had a significant impact on the productivity of the workers, as it was challenging for them to work in an efficient manner. Generally, this meant that most of the workers had difficulties in making use of the system as per expectation, which defined the need to adopt the proposed change. Another key metric to consider is how the proposed change was expected to facilitate the intended use. From the analysis of how the change was designed, its sole intention was to improve user experience by reducing redundancies. The occurrence of the alerts created notable redundancies resulting in instances where most of the users experienced frustrations of alert fatigue. Therefore, this highlighted the value of shifting towards the proposed solution as one of the ways to guarantee enjoyment and productivity. The proposed change was intended to eliminate alert fatigue, as it would be much easier for end-users to scan medications multiple times as per expectation. Reducing the alerts meant that remaining pop-ups would be meaningful to the end-user. In other words, the end-user will most likely pay greater attention to the signals that they receive, which would help reduce possible errors likely to cause patient harm depending on the medication given.
Conclusions
The project highlighted the importance of shifting towards the overall use of an EHR in health facilities considering that it plays a key role in improving efficiency in service delivery. In this project, the focus was on the EPIC EHR, which is a cloud-based system used for purposes of storing digital information. The use of this system in pharmacy introduced a significant challenge due to a high number of alerts in cases where the lot and expiration of a drug do not match. The proposed solution intends to reduce alerts received by end-users, which would make them much more meaningful.
References
Ash, J. S., & Bates, D. W. (2005). Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion. Journal of the American Medical Informatics Association , 12 (1), 8-12.
French, K. E., Speer, B. B., Guzman, A. B., Andrabi, T., Recinos, I., Shook, K. A., ... & Feeley, T. W. (2018). Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost. NEJM Catalyst , 4 (4).
Rinner, C., Sauter, S. K., Endel, G., Heinze, G., Thurner, S., Klimek, P., & Duftschmid, G. (2016). Improving the informational continuity of care in diabetes mellitus treatment with a nationwide Shared EHR system: Estimates from Austrian claims data. International journal of medical informatics , 92 , 44-53.
Wang, H., & Song, Y. (2018). Secure cloud-based EHR system using attribute-based cryptosystem and blockchain. Journal of medical systems , 42 (8), 152.
