COMPUTERIZED PRESCRIBING - BUILDING THE ELECTRONIC INFRASTRUCTURE FORBETTER 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 int eracting with 3 databases: patient drug history, scientific drug infor mation and guideline reference, and patient-specific (weight, laborato ry) data. Current problems with prescribing on which computerized pres cribing could have a positive impact include (1) drug selection; (2) p atient role in pharmacotherapy risk-benefit decision making; (3) scree ning 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 concer ning 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. Devel opment of this tool has been impeded by a number of conceptual, implem entation, and policy barriers. Overcoming these constraints will requi re clinically and professionally guided vision and leadership.