Section 10.1: Overview of Common EHR Platforms (Epic, Cerner, Athena, eCW)

10.1.1 The “Why”: A Fundamental Shift in Perspective and Purpose

For your entire career, your primary digital tool has been a pharmacy dispensing system (PDS). Whether it was PioneerRx, Rx30, EnterpriseRx, or another platform, its core purpose was transactional and linear. A prescription arrives, it is entered, processed through insurance, filled, checked, and dispensed. The software is expertly designed to manage this specific workflow, focusing on inventory, billing, and the safe, efficient production of a final medication product. You have achieved an unconscious fluency in this environment. You can navigate screens, interpret rejection codes, and manage queues with a speed and precision born of thousands of hours of practice.

This module marks the most significant environmental shift in your professional life. You are moving from the familiar, transactional world of the PDS to the sprawling, integrated universe of the Electronic Health Record (EHR) or Electronic Medical Record (EMR). These two terms are often used interchangeably, but there’s a subtle distinction: an EMR is a digital version of a patient’s chart from a single practice, while an EHR is a comprehensive record of a patient’s overall health designed to be shared across different healthcare settings. For our purposes, we will primarily use the term EHR, as it better reflects the interconnected systems you will encounter in a hospital or health system.

It is impossible to overstate how different an EHR is from a PDS. An EHR is not a transactional tool; it is a longitudinal, patient-centric data repository. Its purpose is not just to manage a single encounter or prescription but to house the entirety of a patient’s story—every lab value, every physician’s note, every vital sign, every imaging report, every admission, from birth until the present day. Your pharmacy system knows what medications a patient has received from your pharmacy; the EHR knows why they were prescribed in the first place, whether they worked, what side effects they caused, and how they fit into the patient’s complex clinical picture.

Your role within this new digital ecosystem undergoes an equally profound transformation. In the PDS, you are primarily a verifier and dispenser of a finished product—an order written by a provider. In the EHR, you become a clinical data synthesizer, contributor, and guardian. You are no longer at the end of the chain of command; you are a vital node in the network of clinical decision-making. You will be expected to dive into the patient’s story, analyze disparate pieces of information (a rising creatinine, a falling white blood cell count, a nurse’s note about confusion), and use that data to make proactive recommendations that shape the very orders you will eventually verify. Your digital fluency is a massive asset, but you must now learn to apply it to a much larger, more complex, and more powerful instrument. This section is your orientation to that new instrument.

10.1.2 The Four Titans: Core Philosophies and What They Mean for You

While hundreds of EHR vendors exist, the inpatient and ambulatory markets in the United States are dominated by a handful of major players. For the transitioning pharmacist, you are most likely to encounter one of four systems: Epic, Cerner, athenahealth, or eClinicalWorks (eCW). Understanding the fundamental design philosophy of each company is the key to rapidly achieving proficiency. An EHR’s user interface is not random; it is a direct reflection of the company’s core beliefs about how healthcare data should be organized, accessed, and used. Knowing this “personality” allows you to anticipate how the system will behave.

Masterclass Table: A Comparative Overview of the EHR Market Leaders

Attribute	Epic	Cerner	athenahealth	eClinicalWorks (eCW)
Core Philosophy	Integrated & Unified. The “one patient, one record” mantra. All applications are built in-house on a single database (Chronicles). The goal is a seamless, consistent experience across all modules.	Modular & Interfaced. Grew through acquisition, resulting in a suite of powerful, specialized “best-of-breed” modules (PharmNet, PathNet, etc.) that interface with a central hub.	Cloud-Native & Networked. A single, web-based platform for all clients. The core value is the collective intelligence of the network, sharing data and insights across practices.	Ambulatory-First & All-in-One. Designed from the ground up for the outpatient clinic. Aims to provide every tool a private practice needs (EHR, billing, patient portal) in one package.
Primary Environment	Dominant in large, academic medical centers and integrated health systems. The clear market leader for enterprise-level inpatient care.	A major competitor to Epic in large hospitals and health systems. Also has a significant government presence (VA, DoD).	Primarily focused on ambulatory practices, from small clinics to large physician groups. Making inroads into smaller hospitals.	Extremely widespread in the small-to-medium-sized ambulatory practice market. A powerhouse in the outpatient world.
User Interface (UI) Paradigm	The “Windows” of EHRs. Highly graphical, customizable, and dense. Can feel like a complex desktop application with many windows and toolbars. Consistent look and feel across modules.	Can feel like using different applications that are linked together. The look and feel of the pharmacy module (PharmNet) may differ from the lab module (PathNet). Highly dependent on institutional customization.	Modern, web-based interface. Task-oriented and often feels like using a sophisticated website. Clean, less cluttered, and accessed through a browser.	Data-dense and often described as “busy.” The workflow is heavily centered around the “Progress Note.” Uses icon-based shortcuts (“jellybeans”) for navigation.
What This Means for a Pharmacist	You have access to everything. The seamless integration means you can effortlessly move from reviewing a lab result to reading a cardiology note to verifying a medication. The learning curve can be steep due to the sheer volume of data presented.	You must learn to navigate between modules. Information can feel siloed. Your skill will be in knowing where to click to find the data you need (e.g., jumping from PowerChart to the eMAR). The workflow may feel less fluid than Epic’s.	Your workflow is task-driven and browser-based. Medication reconciliation is often easier due to the “network knowledge” feature. Less common in the inpatient setting where most clinical pharmacists practice.	You must become an expert in the Progress Note view, as it is the central hub of all clinical information for an encounter. You’ll need to learn to filter a high volume of on-screen data to find what is relevant.

10.1.3 Deep Dive: Epic Systems – The Integrated Behemoth

When you step into a major academic medical center in the United States, the odds are overwhelmingly high that you will be working with Epic. Headquartered in Verona, Wisconsin, Epic has become the dominant force in the enterprise EHR market through its relentless focus on a single, unified architecture. Their core belief is that the best and safest patient care comes from having all data—from every clinic visit, every hospital stay, every specialty consult—residing in one database, accessible through one consistent interface. For a pharmacist, working in Epic is like being a detective given access to the entire, unredacted case file from day one.

Key Epic Concepts & Terminology: Your New Vocabulary

Epic has its own language. Learning these key terms is the first step to proficiency. It’s like learning the difference between a “generic” and a “brand” name; they are the fundamental building blocks of communication within the system.

• Hyperspace: This is the name for the Epic desktop client itself. It is the graphical user interface—the “cockpit”—where you will spend your entire day. It’s the equivalent of the main screen of your PDS.
• Storyboard: This is the patient information header, typically located at the top or side of the screen, that is always visible, no matter where you are in the patient’s chart. It contains the most critical, at-a-glance information: patient name, DOB, MRN, allergies, code status, and key diagnoses. Your eyes will be trained to scan this header hundreds of times a day.
• Activities: These are the “tabs” or “modules” listed vertically on the left side of the screen. Each Activity takes you to a different part of the patient’s chart. Common pharmacist-centric Activities include Chart Review, MAR, Meds/Orders, Results, Notes, and Flowsheets. Think of these as the different applications on your smartphone; you tap one to open a specific function.
• Navigators: A Navigator is a structured workflow designed to guide a user through a complex, multi-step process. For example, an Admissions Navigator will have sections for medication history, placing admission orders, and completing required documentation, all in one streamlined view. As a pharmacist, you will frequently work within these Navigators during patient admission, transfer, and discharge.
• BestPractice Advisory (BPA): These are the clinical decision support alerts that pop up during your workflow. They can be triggered by almost anything: ordering a drug the patient is allergic to, a drug-drug interaction, a reminder for renal dose adjustment, or a suggestion to order a required lab test. While critically important for safety, they are also a primary source of alert fatigue. A key skill you will develop is rapidly differentiating a critical, life-saving BPA from a routine, informational one.
• In Basket: This is the secure, internal messaging and task management system within Epic. It is the central nervous system of communication in the hospital. You will receive messages from providers about patients, notifications about orders needing clarification, requests for clinical consults, and tasks assigned to you by other team members. Mastering your In Basket workflow is as important as mastering chart review; it is your primary communication tool and is fully auditable and part of the medical record.

The Pharmacist’s View: Core Epic Workspaces

10.1.4 Deep Dive: Cerner Corporation – The Modular Powerhouse

Cerner, now part of Oracle Health, is the other titan of the inpatient EHR world. If Epic’s philosophy is to build a single, perfectly integrated sedan from the ground up, Cerner’s is to build a powerful truck by selecting the best possible engine, the best transmission, and the best chassis from expert manufacturers and integrating them seamlessly. The company grew significantly by acquiring specialized software companies, leading to a system that is incredibly powerful and deep in its individual components, but which can sometimes feel less unified than Epic’s platform.

Key Cerner Concepts & Terminology: A Different Dialect

Cerner’s vocabulary reflects its more modular architecture. Understanding these terms will help you grasp the system’s structure.

• Millennium & PowerChart: Millennium is the name of the underlying architecture and database that powers the Cerner ecosystem. PowerChart is the main clinical application that you, as a pharmacist, will use to access patient charts. It is the equivalent of Epic’s Hyperspace.
• MPages (Millennium Pages): These are customizable views or dashboards within PowerChart. Your hospital can design specific MPages for different roles. For example, there might be a “Pharmacy MPage” that pulls together the most relevant information for your workflow—active med orders, recent kidney function labs, and new messages—all onto one screen.
• The “-Nets”: This is a classic Cerner feature. Cerner’s different modules often have names ending in “-Net.” For example, PharmNet is the pharmacy module, PathNet is the laboratory module, and RadNet is for radiology. While these are all accessed through PowerChart, they are distinct systems under the hood, which is why the user interface can sometimes change slightly as you move between functions.
• Message Center: This is Cerner’s version of the In Basket. It is your secure messaging hub for all patient-related communication and tasks.
• Discern Alerts: These are Cerner’s clinical decision support pop-ups, equivalent to Epic’s BPAs. They serve the same function of alerting you to potential safety issues, required documentation, or clinical guidance.

The Pharmacist’s View: Core Cerner Workspaces

Your day-to-day work in Cerner will revolve around a few key areas within PowerChart:

• eMAR (Electronic Medication Administration Record): This is your primary view for seeing what medications have been given, when they are next due, and any nurse comments on administration.
• Orders Profile: This is where you will view all active, discontinued, and pending orders, and where you will enter new orders. Pay close attention to the order status filters, as they are key to understanding the current medication plan.
• Results Flowsheet: Similar to Epic, this is a customizable view for trending lab values, vital signs, and other discrete data points over time. Mastering the filters and layout of the flowsheet is critical for clinical monitoring.
• Message Center: As with Epic’s In Basket, diligent management of your Message Center is non-negotiable for effective communication and patient safety.

10.1.5 Deep Dive: athenahealth & eClinicalWorks – The Ambulatory Giants

While most hospital-based clinical pharmacists will work in Epic or Cerner, it is increasingly common for roles to span across different care settings, including affiliated outpatient clinics. Furthermore, as a pharmacist specializing in areas like transitions of care, you will frequently be interpreting records from these dominant ambulatory platforms. athenahealth and eClinicalWorks (eCW) have a massive footprint in the outpatient world, and their design philosophies reflect the unique needs of that environment: speed, efficiency, and robust billing and practice management tools.

athenahealth: The Cloud-Native Disruptor

Athena’s approach is fundamentally different from the on-premise, server-based models of Epic and Cerner. It is a true cloud-based platform, accessed via a web browser like a sophisticated website. This has profound implications for its design and functionality.

• Core Concept: The Power of the Network. Athena’s greatest strength is its networked “knowledge.” Because all clients are on the same, single instance of the software, Athena can aggregate de-identified data from millions of patient encounters. This allows it to embed powerful intelligence into its system. For a pharmacist, the most tangible benefit is in medication reconciliation. Athena can often pull in a more complete medication history from Surescripts and other connected practices on its network than a siloed hospital EHR can.
• User Experience: Task-Oriented and Web-Like. The UI is clean, modern, and built around completing tasks that arrive in a central “Inbox.” The focus is on moving through a workflow—reviewing a lab, signing a prescription, closing a referral loop—as efficiently as possible. It feels less like a dense desktop application and more like a purpose-built web app.

eClinicalWorks (eCW): The Ambulatory All-in-One

eCW’s success lies in providing small to medium-sized practices with a comprehensive, all-in-one solution that is highly functional and customizable. Its design philosophy is centered on the provider’s encounter with the patient.

• Core Concept: The Progress Note is King. The entire eCW workflow is anchored to the patient’s Progress Note for a specific visit. The chart is often structured with a left-hand navigation panel, a central area for the note itself, and a right-hand panel that displays key clinical data (problem list, current medications, allergies). To understand a patient in eCW, you must learn to navigate this tri-panel layout efficiently.
• User Experience: Information Density. The eCW interface can be very “busy.” It prioritizes displaying a vast amount of information on a single screen over minimalist design. This can be overwhelming for new users, but powerful for experienced users who know where to look. The key is learning to use the available filters and customization options to reduce the “noise” and focus on the data that matters for your task.

10.1.6 Universal Truths & Your Transferable Pharmacy Skills

You are not starting from scratch. The skills you have honed over years behind the counter are directly transferable to the clinical EHR environment. The key is to recognize the underlying concept and understand how it has been expanded and adapted for the clinical setting. The “car” is different, but the principles of safe driving remain the same. This is where you connect your past experience to your future role.

Masterclass Table: Translating Your Retail Expertise into EHR Proficiency

Universal EHR Concept	Your Retail Pharmacy Analogy	The Clinical Evolution: What’s New and Different	Your Core Skill to Leverage
Patient Chart/Profile	The patient’s profile in your dispensing software (PDS).	The EHR profile is exponentially richer. It contains not just allergies and a med list, but the entire clinical story: problem lists, surgical histories, lab trends, vital signs, physician notes, imaging reports, and social history.	Attention to Detail. Your ability to systematically scan a profile for key data points (like an allergy) is now applied to a much larger dataset. You must learn to synthesize these new data types to build a complete clinical picture.
Order Entry & Verification	Typing and verifying a new prescription.	Orders are far more complex. You will manage continuous IV infusions, complex chemotherapy regimens, sliding scale insulins, and multi-drug order sets. Orders have statuses like “Signed and Held,” “Active,” and “Discontinued.”	Systematic Process. Your ingrained habit of checking the drug, dose, route, frequency, and patient is the foundation of safe order verification. You will now add a new layer: clinical appropriateness based on the full chart context (e.g., Is this antibiotic appropriate for this patient’s renal function and suspected infection?).
Clinical Alerts (BPA / Discern Alert)	The DUR (Drug Utilization Review) alerts in your PDS (e.g., Drug-Drug Interaction, High Dose, Therapeutic Duplication).	EHR alerts are more varied and intelligent. They can fire based on lab values (e.g., “Alert: Potassium is high, consider holding ACE inhibitor”), formulary status, or institutional guidelines. However, this also leads to significant alert fatigue.	Clinical Judgment. You are already an expert at evaluating DUR alerts. You will now apply that same judgment to a broader set of clinical data. Your most important new skill will be developing a rapid, accurate filter to distinguish critical, must-act-on alerts from informational noise.
Secure Messaging (In Basket / Message Center)	A phone call, voicemail, or fax to a provider’s office to clarify a prescription.	Communication is now asynchronous, documented, and fully integrated into the patient’s record. It is more efficient but also creates a permanent, auditable trail. There is a specific etiquette for professional, clear, and concise digital communication.	Clear Communication. Your experience in concisely explaining a clinical issue to a prescriber over the phone is invaluable. You will now translate that skill into written form, learning to structure your messages with a clear subject, a brief background, your assessment, and a specific recommendation (the SBAR format).
Inventory/Formulary Management	Knowing what’s in stock, what’s on backorder, and suggesting therapeutic alternatives for non-stocked items.	This expands to the hospital formulary. You are the gatekeeper of medication use, responsible for ensuring adherence to the formulary, managing shortages, and recommending cost-effective, clinically appropriate alternatives based on institutional guidelines.	Problem Solving. Your ability to quickly find a solution when a drug is not available is a core competency. In the hospital, this skill is elevated to a system-level responsibility, where your decisions can impact patient safety and the hospital’s budget.

Ultimately, the specific EHR platform you use is just a tool—an instrument. Your true value as a clinical pharmacist comes from the knowledge, judgment, and systematic approach you bring to that tool. This module is designed to make you a master musician, able to play any instrument the hospital places in front of you. By understanding the foundational principles of these systems, you are preparing yourself to be adaptable, efficient, and, most importantly, an invaluable member of the patient care team, no matter the digital environment.