Are we ready to share data from pharmacy information systems to electronic health records?

The use of electronic health records is emerging across North America, but adoption of this tool has been slow. 1 A US survey conducted in 2008 revealed that 100% of pharmacy departments were computerized, but only 10% were using electronic health records. 2 A Canadian survey conducted in 2009 revealed that only 6% of departments were using this type of medical record, 3 even though the Canada Health Infoway is funding implementation plans for electronic health records in most Canadian provinces. 4 Why is this process taking so long, given that pharmacy departments have been computerized for decades? Sharing clinical data for inpatients and outpatients through electronic health records will undoubtedly help to reduce the need to retranscribe information, as well as reducing errors, duplications, and omissions. It should also provide clini-cians with an accurate overview of the state of patients' health, including clinical actions taken. Nevertheless, given the plethora of systems and processes that have already been implemented, data-sharing among existing systems constitutes a major challenge. In fact, these systems feature widely divergent data structures and processes for data management and record-keeping. A limited normative framework exists to determine the optimal structure for data collected in pharmacy information systems and the way in which patients' medication orders are entered into electronic health records and other software. The American Society of Health-System Pharmacists has published a number of statements on robotization and information technologies , 5,6 but neither the Canadian Society of Hospital Pharmacists nor any of the professional regulatory authorities in Canada have published professional guidelines for data maintenance or order exchange in health care settings. We conducted a descriptive pilot project involving several hospital pharmacy departments in Montreal in June 2010. The objective was to describe the content of medication order labels appearing in medication administration records (MARs) produced by various pharmacy information systems and to consider the feasibility of sharing these data with electronic health records. For the pilot study, we prepared 10 prescriptions for a single theoretical patient. Thirteen (41%) of 32 hospitals responded to our invitation to participate and returned a completed MAR for the theoretical patient. For the most part, the MARs returned by the participating pharmacies included expected demographic and clinical data for the patient, except for creatinine clearance (included by only 10 of 13 pharmacies), body surface area (5 of 13), and intolerances (12 of 13). We observed a high disparity in …