What is the ideal medication workflow ?

 Simple – from doctor’s brain to patient’s vein without handwriting, handoffs, or hassle.

Dr. Scarlat’s clear explanations empower healthcare professionals with tools that will enhance any IT project.…it provides a framework that will enable clinicians to communicate with technologists. 

I plan to use this book in the BIDMC medication work, which seeks to achieve zero defects, cost reductions, and patient engagement.   Both clinicians and IT professionals should find the book to be a valuable resource as they create the reformed healthcare delivery system of the future, beyond Meaningful Use.

From the book foreword by John D. Halamka MD


The informatics transformation of American Healthcare as a result of the American Recovery and Reinvestment Act (ARRA) Meaningful Use (MU) program is now truly underway, creating an entirely new language and dimension to the practice of medicine. As physicians (and other clinicians) move through MU, past the stage of commercial technology acquisition and implementation, the need for a deeper understanding of the structure AND function of these new knowledge systems is not only necessary but essential.

Dr. Scarlat’s comprehensive and logically structured handbook acts as a common sense guide to this new world of informatics that should prove invaluable to the clinician making his/her way past the commercial hype into the realm of true understanding of the systems of medical informatics. Well referenced and comprehensive, this work is strongly recommended to the new “meaningful user” as well as those that work with and support clinicians in this essential next generation of American Medicine.

William F. Bria MD, CMIO

President of the Board, Association of Medical Directors of Information Systems (AMDIS)


Dr. Alexander Scarlat’s Electronic Health Record: a Systems Analysis of the Medications Domain is a welcome and valuable addition to the toolkit for IT professionals and clinicians participating in the design or implementation of EHR systems.

As an RN in the healthcare IT field, I appreciate the importance of understanding clinician workflow and the desired future state, particularly in the medication process. Having taught a graduate level overview of information systems class as well, I also understand the challenges some students experience when learning to create entity-relationship diagrams and data flow diagrams. Dr. Scarlat’s easy-to-understand explanations are the most detailed I have seen. This book will be indispensable to students learning system analysis and a valuable adjunct to current professionals as they attempt to represent data and its flow through the EHR system.

Since so many of the Stage 1 Meaningful Use objectives pertain to medications (use of CPOE for medication orders, drug-drug and drug-allergy checks, e-prescribing, active medication list, active medication allergy list, clinical decision support rule, drug formulary checks, and medication reconciliation), Dr. Scarlat’s book is especially timely.

Christine Greifzu, RN-BC, MBA, MSIS


Dr. Scarlat’s Electronic Health Record: a Systems Analysis of Medications Domain is a very useful guide to addressing not only the medication process but many service domains for practice, administration and patient-centered care in the community. The analysis and tools project a deeper understanding of how data are used by senders and receivers and how the capture and storage in appropriate data structures facilitate the data use for clinical decision support, health information exchange and future application with personal healthcare related to knowledge of genetic makeup to diagnose and treat. The critical process of structured system analysis (SSA) is necessary to inductively and deductively view the workflow processes from the point of view of many stakeholders. The SSA process guides open thinking and the data flow diagrams and entity relationship diagrams are types of tools to lead towards better application of data within events, thus better designs and better strategies to deliver care. Data workflow diagrams and the patient-centered process workflows require leveling from high level core practices to minute detail.

This book provides the necessary detail that is often missing in many textbooks. Dr. Scarlat takes the medication process and its interactions between stakeholders (e.g., patient, physician) to detail the interconnectedness necessary for better use of data that goes into and is used from our electronic health records and health information exchanges. Many clinicians and professionals may not appreciate the detail that is necessary to make a better EHR that works for physicians, nurses and pharmacists to more effectively access and use the patient’s information efficiently.

I particularly appreciate Dr. Scarlat’s message about the importance of data dictionaries for the clinician users within data workflow diagrams and entity relationship diagrams. I would agree this resource is to be used by both users and developers as a communication tool and knowledge database to clarify and define the context of terms during the system life cycle: analysis, design, code build, testing, implementation, training and maintenance. The figures and description to analyze the medication process generates thoughtful inclusion of detail such as indications, age bands, and ethnicity which are data components that will support better clinical decisions in the workflow. Genetic personalized healthcare will advance the clinical decisions related to best treatment plan, therefore our EHR systems should continuously evolve to support clinicians by handling the complexity of knowledge and patient information that must be present to make decisions related to age, gender, conditions and genetic makeup.

Dr. Scarlat’s Electronic Health Record: a Systems Analysis of Medications Domain is very useful in health informatics education at university and the HITECH courses within community colleges as well as for any programmers and managers responsible for system analysis and improvements in the design and application of data use.

Jane M. Brokel, PhD, RN


It’s impossible to understand clinical information systems and electronic health records without mastering the medication domain. It encompasses high-value, high-volume therapeutic transactions of indescribable complexity that touch nearly every licensed professional in a hospital, enrobing drug ordering, dispensing, and administration in sophisticated layers of clinical decision support, caregiver work lists, and back-end charging and continuum of care functions.

I am pleased that the topic merits its own formal review and analysis in Dr. Scarlat’s book. I found the user interface chapter immediately useful — in fact, I’m hoping the vendors of my own hospital’s systems take its recommendations to heart!

Mr. HIStalk, Healthcare IT Blogger


Finally, here’s a textbook that the market and the industry has been looking for. 

The author has captured the details of the information flows involved in the EHR while processing an order or prescription from inception to completion.  The book should help any clinician or informatics professional understand what’s happening in the process of medication order, dispense and administer.

Joseph T. Finn, RPh, MBA


With the incredible expansion of medication management information technology, both in the hospital and ambulatory environments, the need for a comprehensive reference text was essential.

Dr. Scarlat’s book fulfills that role and creates a space where clinicians and programmers can share a common knowledge platform to improve and advance the use of medication safety and efficiency in complex EHR systems.

Karl Matuszewski, MS, PharmD


Electronic Health Record: a Systems Analysis of the Medications Domain is a thoughtful and well-constructed manual to understanding and incorporating the complex and many-sided aspects of medication concepts into a coherent and logical informational framework.  Drawing upon foundational data modeling and structured systems analysis techniques, the extensive use of graphical tools such as workflow, dataflow and entity relationship diagrams to illustrate medication management processes  provides the IT professional with a clear and accessible entry to this challenging topic. 

The chapter on medication prescribing is particularly illustrative of the author’s facility for deconstructing complex, intricate medication processes into their granular tasks and activities to show the key interactions and communications among patient, clinician and technologist.   I believe both the experienced and novice healthcare informatics practitioner will find Dr. Scarlat’s book to be a welcome and essential addition their toolkit.

Don Martin, Managing Consultant


In his book, Electronic Health Record, A systems analysis of the Medications Domain, Dr Scarlat provides a very thorough and clear description of the electronic health record (EHR) with an exhibition of the practical applications that make this valuable for healthcare professionals and IT specialists in the field of healthcare.

The first chapter of this book focuses on the introduction of basic concepts that are incorporated in the EHR and the functional features that essential for a robust EHR system. Building on the relevant principles such as dataflow and entity-relationships in the form of conceptual models, Dr. Scarlat seamlessly transitions to a comprehensive display of a physical model in the case of the medications domain. In these chapters the structural and functional aspects of the medication domain such as prescription, ordering (CPOE), dispensing, etc are introduced and integrated. The result is a concise and logical display of the medication system.

While the medication domain is the principle focus in this book, it is clear that the same principle may be applied when considering other vital domains such as laboratory, radiology, other core systems and their interactions. Having a clear understanding of the medication domain including the many functional relationships is important; however, a crucial element for the value of any EHR is the quality of the user interface. The effectiveness and efficiency of an EHR is governed by the usability of the system and its adaptability to clinicians’ thought process in the course of clinical care and ease of use.

Regardless of how inherently sophisticated an EHR may be, one that is cumbersome to use and ineffective in sharing information will lead to inferior medical care and outcomes. In his wonderful chapter on user interface, Dr. Scarlat stresses the importance of the user interface and highlights with practical examples how comprehensive medical information may be effectively displayed and utilized to assist clinicians in providing optimal care, which after all is the purpose of the EHR. In the later chapters the topics of decision support as another layer information feedback to assist in the treatment of patients and the need for standardization of clinical terminology and technical aspects of the EHR structure are addressed and nicely conclude the subject of this book.

I strongly encourage clinicians and IT professionals in healthcare to consider reading this comprehensive and informative book. It will be of value to clinicians since it provides a good overview of the EHR principles (with particular emphasis to medication processes) this helping to shape their expectations of an EHR and contribute to its development. For IT professionals it offers a clear description and insight to the important functional elements of the EHR to assist in its design and develop an appreciating for the needs of clinicians with such a system.

Steven J. Melnick, MD, PhD


When I first saw this book I wasn’t sure whether I could learn much about this subject that I didn’t already know after 15+ years in the healthcare domain. I was pleasantly surprised to see that the book contained very useful information, especially for those getting into the domain.

The book focuses on the medications side (as opposed to procedures, diagnoses, patient-focused portals, etc.). Though medications take center stage, I found that even the introductory materials on electronic health records was quite help for those new to the industry.

If you’re building e-prescribing systems, integrating them into existing EHR systems, working on medication reconciliation, looking at closed loop medication, or any of a myriad of other electronic medication tracking problems you owe it to yourself to get a copy of this book. 

Shahid N. Shah,  Medical informatics guru and blogger


Having worked for more than 25 years as a programmer and software architect I was pleasantly surprised twofold to read Dr. Scarlat’s book:

Surprised, since one doesn’t expect such a methodical informatics textbook coming from a physician… The reader interested in the pure, theoretical aspects of systems analysis, is for the first time, to the best of my knowledge, introduced to the subject without the need to exercise his newly acquired skills with the usual (and now well-worn and boring) examples of store, customer, orders, items on an order, etc. that are usually taught when the subject is introduced in computer sciences 101.
This book uses patients, diseases and medications as examples, and that’s a new, refreshing perspective.

During my career I have worked for several years developing medical software. I remember there was no book around to consult, for someone who hasn’t been initiated in a medical or pharmacy school. Dr. Scarlat book is the first one to explain to non-physicians the complexity of the medications domain: dose, form, brand vs generics, route, strength, etc. and how everything is tied together in a clear, systematic way.
The last chapters of the book detail the requirements for a great user interface, provide a complete clinical decision support algorithm (!) as well as the basics for a data warehouse / reporting application. Last chapter, on standards and vocabularies (a potentially tiresome dull subject in itself) is notably an easy read.
Strongly recommended for anyone studying structured systems analysis in general, or working in the development or implementation of EHRs.

Sami Frank,  Software engineer

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