Computerized prescribing: building the electronic infrastructure for better medication usage.
Computerized prescribing in the practice of medicine is a change that is overdue. Virtually all prescriptions in the United States are still handwritten. Instead, medications should be ordered on a computer interacting with 3 databases: patient drug history, scientific drug information and guideline reference, and patient-specific (weight, laboratory) data. Current problems with prescribing on which computerized prescribing could have a positive impact include (1) drug selection; (2) patient role in pharmacotherapy risk-benefit decision making; (3) screening for interactions (drug-drug, drug-laboratory, drug-disease); (4) linkages between laboratory and pharmacy; (5) dosing calculations and scheduling; (6) coordination between team members, particularly concerning patient education; (7) monitoring and documenting adverse effects; and (8) postmarketing surveillance of therapy outcomes. Computerized prescribing is an important component of clinician order entry. Development of this tool has been impeded by a number of conceptual, implementation, and policy barriers. Overcoming these constraints will require clinically and professionally guided vision and leadership.
Schiff
G D
GD
Department of Medicine, Cook County Hospital, Chicago, Ill 60612, USA. gdschiff@aol.com
Rucker
T D
TD
D002984:Clinical Laboratory Information Systems; D016303:Clinical Pharmacy Information Systems; D003199:Computer Systems; D016208:Databases, Factual; D004346:Drug Information Services; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D015274:Interdepartmental Relations; D016347:Medical Records Systems, Computerized; D012984:Software; D014481:United States