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Nelson SD, Department of Veterans Affairs, Salt Lake City, UT; University of Utah, Salt Lake City, UT; LaFleur J, University of Utah, Salt Lake City, UT; Department of Veterans Affairs, Salt Lake City, UT; Del Fiol G, University of Utah, Salt Lake City, UT; Evans RS, Intermountain Healthcare, Salt Lake City, UT; University of Utah, Salt Lake City, UT; Weir C, Department of Veterans Affairs, Salt Lake City, UT; University of Utah, Salt Lake City, UT;
Objectives:
Pharmacists are important healthcare team members, yet compared to physicians and nurses, little is known about their information needs or use of the electronic health record (EHR). The purpose of this study is to explore how pharmacists use the EHR in preparing for clinical rounds.
Methods:
We directly observed seven clinical inpatient pharmacists as they interacted with the EHR preparing for clinical rounds at the Department of Veterans Affairs Medical Center in Salt Lake City, Utah. We recorded pharmacists evaluating 13 new and 19 familiar patients. We used a mixed-methods approach with direct observation, eye-tracking video capture, contextual inquiry, and interviews. We annotated video using qualitative software, which we then analyzed for qualitative and descriptive reporting. We used eye-tracking data to enhance context of audio, video, and field notes.
Results:
It took pharmacists an average of 11:31 (mm:ss) (median: 10:42, IQR: 9:51 to 14:46) to evaluate a new patient, and 3:47 (median: 1:46, IQR: 0:56 to 4:51) to review familiar patients using the EHR. Pharmacists spent 50% of their time reading information from the EHR, such as notes, medication lists, printed papers (active inpatient and outpatient medication lists), recent laboratory results, and provider orders (especially over the last 24 hours). Pharmacists spent 27% of their time copying EHR data onto paper, such as the patient's medical history (problem lists), laboratory results, reminders (such as recommendations or questions for the team), medication doses administered, medication lists (such as medications not restarted upon admission), and highlighting/annotating written notes. Pharmacists used sources of information outside of CPRS, such as VistA Imaging, and non-EHR sources, such as whiteboards and paper. Paper was heavily used in preparation for rounds.
Implications:
We found that pharmacists spent considerable amounts of time gathering information from the EHR and integrating that data by writing it down on printed medication lists, suggesting that the way information is displayed in the EHR does not meet the cognitive model or needs of pharmacists.
Impacts:
In an environment where minutes count, this study can inform the development of technologies to meet information needs of the pharmacists in caring for their patients.
