Survey: Nearly All U.S. Hospitals Use EHRs, CPOE Systems

Sept. 11, 2017
Ninety-nine percent of hospitals across the country now use electronic health record systems (EHRs), compared to about 31 percent in 2003. Computerized prescriber-order-entry (CPOE) systems with clinical decision support are used by 96 percent of hospitals, according to the ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing—2016.

Ninety-nine percent of hospitals across the country now use electronic health record systems (EHRs), compared to about 31 percent in 2003. Computerized prescriber-order-entry (CPOE) systems with clinical decision support are used by 96 percent of hospitals, according to the ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing—2016.

The survey by the American Society of Health-System Pharmacists (ASHP) examines the adoption of technology that improves medication use. Implementation of technologies such as EHRs, CPOE systems, and barcode-assisted medication administration systems support pharmacists in their efforts to increase medication safety and provide effective and efficient patient care.

The survey findings indicate that pharmacists continue to expand their role in improving the prescribing of medications in both hospital and outpatient settings. The adoption of EHRs and medication-use technologies has contributed to this growth, the survey authors wrote.

The rapid implementation of health information technology by hospitals has led to a sharp increase in paperless care. According to the ASHP survey, almost all hospitals across the country now use EHRs. The use of CPOE systems by hospitals has also risen dramatically. Over the past 13 years, the number of hospitals that use paper-only patient health records has declined from 69 percent to 1 percent. In 2008, about 38 percent of hospitals used hand-written medication orders; in 2016, fewer than 3 percent of hospitals use hand-written orders. In addition, almost 93 percent of hospitals in 2016 use barcode medication administration systems, the survey found.

“In addition to improving medication safety, the increased use of information technology shows great potential for pharmacists to spend more and more time providing comprehensive medication therapy management in and across all settings of patient care,” ASHP CEO Paul W. Abramowitz, Pharm.D., said in a statement. “These positive findings move us closer to achieving ASHP’s vision that medication use will be optimal, safe, and effective for all people all of the time.”

The speed at which EHR systems and technologies are being implemented by hospitals was a notable survey finding. “These developments clearly have the potential to improve access to clinical information to all caregivers and provide a platform for clinical decision support that offers safety alerts in real time,” wrote survey authors Douglas J. Scheckelhoff, senior vice president, Office of Practice Advancement at ASHP; Craig A. Pedersen, Ph.D.; and Philip J. Schneider.

The survey also evaluated pharmacists’ contributions to patient care activities during transitions of care, a period that is fraught with risk for medication errors and discrepancies in care. ASHP’s national survey showed that pharmacist and pharmacy technician use of medication histories at admission increased from 54 percent in 2012 to nearly 75 percent in 2016. Pharmacist-provided medication counseling at discharge more than doubled, from 22 percent in 2012 to 45 percent in 2016.  

Drug policy development by pharmacy and therapeutics committees continues to be an important strategy for improving prescribing, the survey authors wrote. Strict formulary systems are maintained in 63 percent of hospitals, and 90 percent of hospitals use clinical practice guidelines that include medications. Pharmacists have the authority to order laboratory tests in 90 percent of hospitals and order medications in 87 percent of hospitals. Therapeutic interchange policies are used in 89 percent of hospitals. In addition, transitions-of-care programs are increasing in number, with 35 percent of hospitals now offering discharge prescription services. Pharmacists practice in 39 percent of hospital ambulatory or primary care clinics. The most common service offered by pharmacists to outpatients is anticoagulation management (26 percent). When pharmacists practice in ambulatory care clinics, 64 percent have prescribing authority through collaborative practice agreements.

ASHP’s national survey, which is organized into six components of the medication-use system (prescribing, transcribing, dispensing, administration, monitoring, and patient education), provides an overall picture of the contemporary roles that pharmacists play in managing medication use. The survey focuses on two components of the medication-use system each year, the survey authors wrote. 

The 2016 survey evaluated practices and technologies related to prescribing and transcribing, and included data from 392 hospitals in the United States ranging in size from fewer than 50 beds to more than 600 beds. 

The survey was published in the September 1, 2017, issue of AJHP (American Journal of Health-System Pharmacy).

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