Section 1: Common EHR Systems: Epic, Cerner, Meditech, and Allscripts

18.1.1 The “Why”: Beyond the Dispensing Screen

In your pharmacy, the computer system is the central nervous system of your workflow. Whether you’ve used EnterpriseRx, PioneerRx, Rx30, or another system, you are an expert at navigating its interface to accomplish a specific set of tasks: data entry, adjudication, inventory management, and dispensing. Your interaction with the software is fundamentally transactional. You input data to produce a tangible output—a labeled vial and a paid claim. Your mastery is measured in speed, accuracy, and efficiency within this defined workflow.

As you transition into a prior authorization specialist role, your relationship with the primary software—the Electronic Health Record (EHR) or Electronic Medical Record (EMR)—undergoes a profound transformation. The EHR is not a transactional tool; it is an investigative one. It is not merely a patient’s medication list; it is the sprawling, complex, and often messy digital narrative of their entire clinical journey. Your goal is no longer to simply process an order that appears on your screen. Your new primary objective is to dive deep into the patient’s chart to find the answer to a single, critical question: “What is the clinical story that justifies the need for this specific medication?”

This requires a complete mental shift. You must move from being a user of a dispensing system to becoming a forensic data analyst of a clinical one. You are a detective, and the EHR is your case file. The information you need is rarely packaged neatly on the main screen. It is scattered across progress notes, lab results, imaging reports, consultant letters, and past admission records. Mastering the dominant EHR systems—Epic, Cerner, Meditech, and Allscripts—is not about learning a new software program. It’s about learning four different layouts for the same investigative library. This section is your orientation to the architecture, language, and navigational quirks of each of these digital environments, equipping you to find the clinical evidence you need, regardless of the platform.

18.1.2 Epic: The Integrated Universe

Market Position: Epic is the dominant player in the U.S. hospital market, particularly in large, academic medical centers and integrated health systems. If you work in a hospital setting, there is a very high probability you will use Epic. Its defining philosophy is a single, integrated patient record across all care settings—inpatient, outpatient, specialty clinics, and sometimes even home health. This is both its greatest strength and a source of its complexity.

The Look and Feel: Epic is known for a relatively clean, customizable, and graphically-driven user interface. It is often described as “Windows-like.” The system is organized around “Activities” (tabs on the left side of the screen) that open into specific workspaces. Information is densely packed, and the sheer volume of data can be overwhelming initially. The key to mastering Epic is learning how to filter out the noise and focus on the most relevant clinical data streams for your PA investigation.

Pharmacist’s First Glance: Navigating the Epic Chart

When you first open a patient’s chart in Epic, you are typically brought to the “Chart Review” or “Snapshot” activity. Your eyes need to know where to go to build a quick clinical picture. This is your 30-second orientation before you begin your deep dive.

Masterclass Table: Translating Retail Pharmacy Tasks to Epic Workflows

Your Goal (from Retail Experience)	Epic Activity / Workflow	Pharmacist’s Deep Dive & “Gotchas”
“Let me check your profile.” (Reviewing all active and past meds)	MAR Activity: The Medication Administration Record shows what is currently ordered, scheduled, and administered. Medications Activity: A more comprehensive view, including outpatient meds, historical prescriptions, and discontinued orders.	Critical Pitfall The MAR only shows inpatient orders. For a PA, you MUST check the Medications activity to see the patient’s home medication list and what they were taking before admission. Failure to do this is a common source of error. Use the filters in the Medications activity to view “Discontinued” or “Historical” meds to find evidence of past treatment failures for step-therapy PAs. Look for “Reconciled” medications on admission. This is often the most accurate source for a patient’s home regimen.
“What are your allergies?”	Allergies Activity: A dedicated section listing all documented allergies and their reaction details. This is also prominently displayed in the StoryBoard.	Always investigate the details of the reaction. “Rash” is very different from “Anaphylaxis.” A PA for a non-preferred drug is much stronger if the preferred alternatives caused a severe reaction. Be wary of “Allergy: Codeine – Nausea.” This is an intolerance, not a true allergy, and payers will almost always deny a PA for a branded opioid based on this.
“I need to check your labs.”	Results Review Activity: The central hub for all lab results, imaging reports, and other diagnostic tests.	Power User Tip Learn to use the “Graph” function in Results Review. Trending a patient’s Hemoglobin A1c, LFTs, or serum creatinine over time tells a much more powerful clinical story for a PA than a single, isolated lab value. Use the search bar to find specific results quickly (e.g., “HCV RNA,” “BNP”). Look at the “Microbiology” tab to find culture and sensitivity results that can justify a specific high-cost antibiotic.
“Let me see the doctor’s notes.”	Notes Activity: A chronological listing of all clinical notes from every provider (physicians, nurses, therapists, etc.). Chart Search: Epic’s powerful global search function.	The volume of notes can be immense. Use filters to narrow down by author (e.g., “Cardiology”) or note type (“H&P,” “Consult Note”). Chart Search is your best friend. If you need to prove a patient failed metformin, searching the entire chart for the word “metformin” will instantly pull up every note where it was mentioned, often revealing the reason for discontinuation (e.g., “patient unable to tolerate metformin due to severe GI side effects”). For a PA, the “History and Physical (H&P)” and specialist “Consult Notes” are often the most valuable sources of detailed clinical justification.

18.1.3 Cerner: The Workflow-Centric Powerhouse

Market Position: Cerner (now part of Oracle Health) is the other major player in the hospital EHR market, often found in large health systems and community hospitals. It competes directly with Epic and holds a significant market share. While Epic is often described as a vast database, Cerner is frequently viewed as more workflow-centric.

The Look and Feel: Cerner’s interface, often referred to as PowerChart, can feel more modular and component-based than Epic’s. The screen is often divided into multiple panes or “components” that can be rearranged. The core navigational element is often a menu bar on the left, but instead of Epic’s “Activities,” Cerner uses a more traditional folder-like structure. Many clinicians find Cerner’s learning curve slightly steeper than Epic’s, but praise its power once the workflow is mastered. For a pharmacist, the key is understanding that different “views” or “MPages” are designed for different clinical roles, and you need to know which ones are built for medication-focused investigation.

Pharmacist’s First Glance: Orienting in Cerner PowerChart

When you open a patient’s chart in Cerner, you’ll land on a summary page. The layout can vary significantly from one hospital to another based on customization, but the core components are consistent.

Masterclass Table: Translating Retail Pharmacy Tasks to Cerner Workflows

Your Goal (from Retail Experience)	Cerner Menu Item / Workflow	Pharmacist’s Deep Dive & “Gotchas”
“Let me check your profile.”	MAR (or eMAR): The electronic Medication Administration Record, showing inpatient medications. Medication List: A more comprehensive view designed to reconcile home medications with inpatient orders.	Critical Pitfall Cerner’s “Medication List” functionality can be powerful but also confusing. There are often multiple lists (e.g., “Home Medications,” “Admission Med Rec,” “Current Orders”). You must carefully review all of them to build a full picture and identify any discrepancies, which are common. Pay close attention to the “Status” column. Look for “Discontinued,” “On Hold,” or “Patient Reported” to find clues for past treatment trials. The Medication Reconciliation history is a goldmine for PA justification. It often contains notes about why a home medication was stopped or changed upon admission.
“What are your allergies?”	Allergies Menu Item: Usually a top-level, dedicated section. The information is also pulled into the Banner Bar.	Cerner makes a good distinction between “Allergy” and “Intolerance.” Be sure to document this correctly. A payer will care about a true sulfa allergy when reviewing a PA for Bactrim, but not an intolerance causing mild stomach upset. Review the “Reaction” details. You are looking for specific, documented evidence to support using a non-preferred agent.
“I need to check your labs.”	Results Review: A highly customizable section for all results. May also be called “Flowsheet” in some builds.	Power User Tip Cerner’s strength is in creating custom views. Take the time to build your own “PA Investigation View” in Results Review that pulls together the common labs you always look for: CBC, CMP, A1c, LFTs, SCr, and relevant microbiology or pathology results. This will save you immense time. Results are often grouped by date. Learn how to change the view to “List” or “Group by Test” to trend a specific value over time. Pathology and biopsy reports are critical for oncology PAs. They are found in Results Review but may be under a different tab than labs.
“Let me see the doctor’s notes.”	Clinical Notes: The main repository for all narrative notes. Documents: Scanned outside records, faxes, and other documents are often stored here.	Cerner’s note filtering tools are essential. You can filter by service (e.g., “GI,” “ID”), document type, or date range. Do not try to read the entire list chronologically. The “Documents” section is often overlooked but crucial. This is where you will find the records from the referring physician or outside hospital that contain the original justification for a specialty drug. It’s the digital equivalent of a faxed-over chart. Cerner’s search functionality may not be as globally integrated as Epic’s Chart Search. You may need to search within the “Clinical Notes” section specifically, rather than across the whole chart.

18.1.4 Meditech: The Veteran Workhorse

Market Position: Meditech has been a stalwart in the EHR market for decades, particularly in small-to-medium-sized community hospitals and rural healthcare facilities. It is known for its stability, reliability, and often, a lower price point compared to Epic and Cerner.

The Look and Feel: Meditech has several platforms, and the user experience can vary dramatically. Older versions (like Meditech MAGIC) are character-based, often called “green screen,” and rely heavily on keyboard shortcuts and function keys. Newer platforms (like Meditech Expanse) are modern, web-based, graphical interfaces that are much more intuitive. As a PA specialist, you may encounter any of these versions. The key challenge with older Meditech versions is the lack of a point-and-click interface. You must learn the keyboard commands to navigate efficiently. The information is highly structured and siloed, meaning you have to intentionally navigate to different modules (Pharmacy, Lab, Order Entry) to piece together the clinical story.

Pharmacist’s First Glance: Surviving a Character-Based Interface

If you encounter an older Meditech system, do not panic. The information is all there. Your approach needs to be more deliberate and methodical. Newer Expanse versions will feel much more familiar.

Masterclass Table: Translating Retail Pharmacy Tasks to Meditech Workflows

Your Goal (from Retail Experience)	Meditech Module / Workflow (Classic vs. Expanse)	Pharmacist’s Deep Dive & “Gotchas”
“Let me check your profile.”	Classic: Pharmacy Module (PHA) -> View Active Orders. Requires separate look-up for discontinued meds. Expanse: A unified “Medications” widget or section on the patient’s main chart view.	Critical Pitfall In older Meditech versions, data is heavily siloed. The Pharmacy module may not show medications administered by nursing that were not dispensed from the pharmacy (e.g., patient’s own meds). You must cross-reference the PHA module with the electronic MAR (eMAR) in the nursing module. Learning the status codes is critical. “DC” for discontinued, “HD” for hold. There often isn’t a single “home medication” list. You may need to find it documented in the H&P note within the EMR module.
“What are your allergies?”	Classic: Often part of the “Admissions (ADM)” or “EMR” module. It’s a specific screen you must navigate to. Expanse: Prominently displayed in a dedicated widget and the patient header.	The free-text nature of older Meditech versions means reaction details can be inconsistent. You may see “hives,” “anaphyl,” or just “allergic.” This requires you to dig into the notes for clarification. Always confirm allergies documented at admission are still accurate.
“I need to check your labs.”	Classic: Laboratory Module (LAB). You will view results by category (Chemistry, Hematology) and then by date. Expanse: A modern “Results” tab with graphing and trending capabilities, similar to Epic/Cerner.	Power User Tip In classic Meditech, learn the “Recent Results” function. It often provides a reverse chronological list of the last 24-48 hours of labs on one screen, which is much faster than drilling down into each category individually. Radiology and pathology reports are in separate sections of the EMR/PCI module. You must exit the LAB module to view them. Trending labs in older versions requires you to manually go back day by day. It’s tedious but necessary for building a clinical case over time.
“Let me see the doctor’s notes.”	Classic: EMR or Patient Care Inquiry (PCI) module. Notes are typically listed chronologically. Expanse: A “Notes” or “Documentation” tab with advanced filtering.	The biggest challenge in older versions is the lack of a global search. You cannot search the entire chart for a keyword. You must open notes one by one. Prioritize! Start with the most recent H&P, discharge summary from a prior admission, or a specialist consult note. This is where the justification you need is most likely to be found.

18.1.5 Allscripts: The Outpatient & Ambulatory Specialist

Market Position: Allscripts (now part of Veradigm) has a strong presence in the outpatient and ambulatory clinic space. While they have inpatient EHRs (like Sunrise), you are most likely to encounter their products (like Allscripts Professional or TouchWorks) when working with physician offices, specialty clinics, or in a PBM/managed care setting that interfaces directly with these providers.

The Look and Feel: Allscripts platforms are generally designed around the rhythm of an office visit. The interface is often organized into “tabbed” sections within a patient’s chart that mirror a paper chart: Demographics, Problems, Medications, Notes, etc. They are typically user-friendly for clinicians in the process of documenting a visit and placing orders. For a PA specialist, the experience can be very streamlined, as the necessary information (diagnosis, medication, note for that visit) is often well-organized on a single screen. The challenge arises when you need to find historical data from previous visits or specialists.

Pharmacist’s First Glance: The Clinic Chart Layout

The Allscripts interface is focused on efficiency for the provider. Your job is to leverage that structure to find exactly what you need for the PA, which is often the note from today’s or the most recent visit.

Masterclass Table: Translating Retail Pharmacy Tasks to Allscripts Workflows

Your Goal (from Retail Experience)	Allscripts Tab / Workflow	Pharmacist’s Deep Dive & “Gotchas”
“Let me check your profile.”	Meds Tab: This is typically a very clean, well-organized list of the patient’s current, past, and prescribed medications.	Power User Tip Allscripts often has excellent integration with e-prescribing and pharmacy fill data via Surescripts. The “Meds” tab might show not only what was prescribed but also if the patient has actually been filling it, which is powerful information for a PA. Look for the “Discontinued Reason” if available. Providers often document this well in the outpatient setting.
“What are your allergies?”	Allergies Tab or Section: A dedicated, easy-to-find list.	Because it’s an outpatient system, the allergy list is often reviewed and updated at every single visit. It tends to be more accurate and up-to-date than in some hospital systems where it might only be reviewed on admission.
“I need to check your labs.”	Results Tab: A repository for lab and imaging results ordered by the clinic.	Critical Pitfall The “Results” tab will only show results for tests ordered by that specific clinic or provider. If the patient had labs done at a hospital or with another specialist, those results will likely not be in the Allscripts system unless they were manually scanned in. You must look in the “Documents” or “Scanned” section for outside records.
“Let me see the doctor’s notes.”	Notes Tab: Organized by encounter date. The note from the visit that generated the prescription is your primary target.	Outpatient notes are often more concise and to-the-point than inpatient notes. Look for the “Assessment and Plan” (A&P) section at the end of the note. This is where the provider explicitly states the diagnosis and their reason for prescribing the medication. For PAs, a specialist’s “Consult Note” in Allscripts is often the single most important document you can find. It contains the entire clinical justification you need to submit to the payer.