Closed-Loop Medication Management with an Electronic Health Record System in U.S. and Finnish Hospitals

Susan B. Shermock, Kenneth M. Shermock and Lotta L. Schepel ()
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Susan B. Shermock: Howard County Medical Center, The Johns Hopkins Health System, Department of Pharmacy Services, 5755 Cedar Lane, Columbia, MD 21044, USA
Kenneth M. Shermock: Center for Medication Quality and Outcomes, The Johns Hopkins Health System, 600 North Wolfe Street Carnegie 180, Baltimore, MD 21287, USA
Lotta L. Schepel: Quality and Patient Safety Unit and HUS Pharmacy, HUS Joint Resources, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland

IJERPH, 2023, vol. 20, issue 17, 1-14

Abstract: Many medication errors in the hospital setting are due to manual, error-prone processes in the medication management system. Closed-loop Electronic Medication Management Systems (EMMSs) use technology to prevent medication errors by replacing manual steps with automated, electronic ones. As Finnish Helsinki University Hospital (HUS) establishes its first closed-loop EMMS with the new Epic-based Electronic Health Record system (APOTTI), it is helpful to consider the history of a more mature system: that of the United States. The U.S. approach evolved over time under unique policy, economic, and legal circumstances. Closed-loop EMMSs have arrived in many U.S. hospital locations, with myriad market-by-market manifestations typical of the U.S. healthcare system. This review describes and compares U.S. and Finnish hospitals’ EMMS approaches and their impact on medication workflows and safety. Specifically, commonalities and nuanced differences in closed-loop EMMSs are explored from the perspectives of the care/nursing unit and hospital pharmacy operations perspectives. As the technologies are now fully implemented and destined for evolution in both countries, perhaps closed-loop EMMSs can be a topic of continued collaboration between the two countries. This review can also be used for benchmarking in other countries developing closed-loop EMMSs.

Keywords: medication safety; medication error; closed-loop; electronic medication management system; electronic health record; computerized provider order entry; clinical decision support system; barcode assisted medication administration; automated dispensing cabinet; EPIC (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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