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.