Background and importance Healthcare is currently undergoing a transformation to a digital platform and implementing an integrated electronic medical record (ieMR). The ieMR delivers an integrated suite of digital services that improve safety, efficiency and quality in clinical workflow processes. This is changing the future of healthcare and the roles of healthcare professionals. The changing face of the healthcare system is an opportune time to review current processes. Therapeutic drug monitoring (TDM) is currently planned and ordered by medical officers at an outer metropolitan hospital. The role of the pharmacist is sporadic. There is currently minimal data about the impact of a digital hospital system on traditional roles and current processes within the healthcare system.

Aim and objectives To review the impact of ieMR on the TDM process within an outer metropolitan hospital.

Material and methods A retrospective audit was conducted on TDM over two 12 month periods. The periods were 2016 (a paper based hospital system) and 2018 (a digital hospital system). Patients were identified using the electronic pathology database. Patients were excluded if <18 years of age, it was an outpatient setting or within the emergency department. Progress notes, medication charts, ieMR and other relevant pathology were reviewed. They were assessed for appropriateness of the timing of collection, compliance to recommended TDM guidelines and the documented involvement of the pharmacist.

Results There were 10 medications included in the study, which covered 1686 and 1251 tests in 2016 and 2018, respectively. Of these, 40.6% at cost of $AUD15 999.43 were collected at an inappropriate time in 2016 and 41.9% at a cost of $AUD11 545.27 in 2018, making interpretation difficult. There was documented pharmacist advice in 8.6% in 2016 and in 13% in 2018 of all TDM results. The TDM function in ieMR was only used in 3% of all tests.

Conclusion and relevance TDM has a large impact on the therapy and outcome of patients. This review demonstrated that ieMR did not have a significant impact on TDM and demonstrated a minimal role for the pharmacist. These preliminary results showed that a review of the current TDM process is required and with their drug and pharmacokinetic knowledge, a greater impact and role of the pharmacist is required.

References and/or acknowledgements No conflict of interest.