BackgroundWith the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for “meaningful use” (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems.ObjectiveThe Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy.MethodsWe gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group.ResultsStakeholders’ knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs.ConclusionsAlthough MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways. Future certification rules and requirements should enhance EHR functionalities critical for safer prescribing of medications in children.

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The prosecution and ultimate conviction of nurse RaDonda Vaught is both a warning and a call to action for pharmacists and the profession of pharmacy. This essay outlines nine steps that should be taken to maximize patient safety and minimize the risk of criminal prosecution for harm that results from human error. These include advocating for safe practices that reduce the risk of wrong drug errors; using pharmacy professional organizations to educate prosecutors about just culture and system safety; strengthening the focus on at-risk behaviors and the normalization of deviance; training a cohort of clinicians to serve as expert witnesses for the defense; embracing communication and resolution programs as responses to unexpected harm; encouraging and supporting conservative medication use to minimize exposure to medication risks; drawing attention to production pressures and their impact on patient safety and clinician burnout; promoting proactive surveillance for adverse drug effects; and standing in solidarity with other health professions, especially nursing.

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