Table 1.

Key changes in the medication management process before and after implementing a new electronic health record (EHR) system (APOTTI).

Medication Process before APOTTI	Medication Process with APOTTI
Multiple EHRs in the hospital and medications are ordered in multiple systems.	There is one EHR and ordering system in the entire hospital.
Medication reconciliation in the EHR system is based only on hospital policy and documented in free text. Pharmacists are not widely involved in the process.	Medication reconciliation and a structured home-medication list are mandatory for in-patient medication. A home-medication list is integrated into the Kanta system, which holds electronic prescriptions [20]. Pharmacists are involved in medication reconciliation in many units.
Prescribing with free text orders and prescriptions in variable places in EHR systems.	Prescribing with structured order and prescription forms in specific medication applications in one EHR system.
Prescribing and ordering with the brand name.	Prescribing and ordering with the generic name.
Clinical decision support system (CDSS) for interactions and allergy warnings	More sophisticated CDSS, e.g., with dose warnings (including dosing with older patients and renal impairment), duplicate medications, and electronic best practice advice (BPA)
Primarily nurses transcribe orders to patients’ medication list. Verbal orders are common.	Primarily physicians document orders directly to patients’ medication list. Verbal orders are allowed only in limited situations.
Orders are not verified.	Pharmacists verify orders in some units.
Automated dispensing cabinets not integrated into the EHR system	Automated dispensing cabinets integrated with APOTTI enable the dispensing of medicines according to electronic orders.
Dispensing and preparing the medicines in units for the next shift or day (24 hours), some of the units use paper-based medication lists.	Dispensing and preparing the medicines in a timely manner (max. 2 hours before administration) by using the EHR system’s medication application and barcode scanning.
Medicines dispensed in the unit are double-checked by another nurse (manual double-check process).	Dispensing the right medicine is assured by scanning the barcodes of the medicine packages (no unit doses). A manual double-check process is used only when the barcode is not available or in use and for high alert medications (in addition to scanning).
Medicines prepared (e.g., dissolved and diluted) are double-checked in a few units, paper-based instructions for preparing medicines.	Preparing is documented by scanning the barcodes of the medicines, and EHR’s medication application gives the instructions for preparing. The manual double-check process is used only when the barcode is not available or in use and for the high alert medications (in addition to scanning).
The right patient and right medicine are assured manually when administering the medicine.	When administering the medicine, the right patient and medicines are assured by using the barcodes.
Medication administration is recorded with delay and only some of the medicines are recorded (e.g., high alert medications).	Medication administration is recorded in a timely manner at the bedside, and all medicines are recorded.