Influence of pharmacy practice on community pharmacists' integration of medication and lab value information from electronic health records.

OBJECTIVES: To describe how an electronic health record (EHR) was integrated into community pharmacists' patterns of patient care and to explore factors that are related to the use of medication and laboratory value information from the EHR. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: Edmonton, Canada, between November 2008 and March 2009. PARTICIPANTS: 16 pharmacists, 3 pharmacy technicians, and 2 pharmacy interns from primary care networks, long-term care settings, community independent and chain pharmacies, and grocery store pharmacies. INTERVENTION: Qualitative interviews. MAIN OUTCOME MEASURE: Pharmacists' self-reported use of EHR. RESULTS: Pharmacists in a patient-centered care practice (involving medication therapy management activities) were more likely to adopt the EHR for medication history and laboratory values, whereas pharmacists whose practice was focused on medication dispensing primarily used the EHR for patient demographic and dispensing records. Six general factors influenced the use of EHR: patients, pharmacists, pharmacy, other health professionals (i.e., physicians), EHR, and environment. Access to the medical record versus EHR and timeliness were barriers specific to pharmacists in a patient-centered practice. Factors that affected EHR use for pharmacists with primarily a dispensing practice were role understanding, dispensing versus lab records, valid reasons for using EHR, and fear of legal and disciplinary issues. CONCLUSION: Many community pharmacists embraced the EHR as a part of practice change, particularly those in patient-centered care practices. Practice type (patient-centered care or dispensing) greatly influenced pharmacists' use of EHR, specifically laboratory values. Because these qualitative findings are exploratory in nature, they may not be generalized beyond the participating pharmacies.