Electronic information and clinical decision support for prescribing: state of play in Australian general practice.
BACKGROUND
Investments in eHealth worldwide have been mirrored in Australia, with >90% of general practices computerized. Recent eHealth incentives promote the use of up to date electronic information sources relevant to general practice with flexibility in mode of access.


OBJECTIVE
To determine GPs' access to and use of electronic information sources and computerized clinical decision support systems (CDSSs) for prescribing.


METHODS
Semi-structured interviews were conducted with 18 experienced GPs and nine GP trainees in New South Wales, Australia in 2008. A thematic analysis of interview transcripts was undertaken.


RESULTS
Information needs varied with clinical experience, and people resources (specialists, GP peers and supervisors for trainees) were often preferred over written formats. Experienced GPs used a small number of electronic resources and accessed them infrequently. Familiarity from training and early clinical practice and easy access were dominant influences on resource use. Practice time constraints meant relevant information needed to be readily accessible during consultations, requiring integration or direct access from prescribing software. Quality of electronic resource content was assumed and cost a barrier for some GPs.


CONCLUSIONS
The current Australian practice incentives do not prescribe which information resources GPs should use. Without integration into practice computing systems, uptake and routine use seem unlikely. CDSS developments must recognize the time pressures of practice, preference for integration and cost concerns. Minimum standards are required to ensure that high-quality information resources are integrated and regularly updated. Without standards, the anticipated benefits of computerization on patient safety and health outcomes will be uncertain.
Department of Clinical Pharmacology, The University of Newcastle, Clinical Sciences Building, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia. jane.robertson@newcastle.edu.au
Jane
J
Robertson
Annette J
AJ
Moxey
David A
DA
Newby
Malcolm B
MB
Gillies
Margaret
M
Williamson
Sallie-Anne
SA
Pearson
D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data* / Q000639:trends; D055695:Electronic Prescribing; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data* / Q000639:trends; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data* / Q000639:trends; D009517:New South Wales