Exploring hospital staff experiences and requirements for safer and more equitable EHR-integrated medication...

Medication-related harm remains a global challenge, causing preventable illness, mortality, and cost. Electronic health records (EHRs) and electronic medication management systems (eMMS) aim to improve safety through standardisation and decision support, yet persistent usability issues, fragmented workflows, and limited consideration of equity continue to compromise outcomes, particularly for Indigenous, older, and disabled populations.

To explore how doctors, nurses, pharmacists, digital health professionals, and organisational leaders experience EHR-integrated medication systems with particular attention to medication safety, workflow, and inequities.

An exploratory descriptive qualitative study was conducted at a large tertiary hospital in New Zealand (January - February 2025). Data were analysed using Braun and Clarke's reflexive thematic analysis, guided by User-Centred Design, the Sociotechnical Model, the Digital Health Equity Framework, and the Māori wellbeing model Te Whare Tapa Whā. Rigour was supported through reflexive journaling, supervisory review, and COREQ adherence.

Thirteen semi-structured interviews and two focus groups were held with 22 participants. Three overlapping themes were identified. System design and organisational factors influencing medication safety showed how complex interfaces, rigid automation, and unreliable infrastructure increased cognitive load and required vigilance. Limited recognition of cultural and social needs in eMMS, revealed that missing fields for language, disability, and family context constrained culturally safe communication and equitable care. Design priorities for safer, more inclusive systems captured participants' vision of adaptive decision support, integrated data views, and embedded equity features such as interpreter prompts, disability and family engagement fields, and co-design to ensure systems evolve with clinical and cultural practice.

Improving medication safety requires more than digital transformation of medication processes. Integrating user-centred design, sociotechnical awareness, and equity principles can create intelligent, context-aware systems that support, rather than replace, clinical judgement, empathy, and human connection in patient care.