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Special Communication |

Computerized Prescribing:  Building the Electronic Infrastructure for Better Medication Usage

Gordon D. Schiff, MD; T. Donald Rucker, PhD
JAMA. 1998;279(13):1024-1029. doi:10.1001/jama.279.13.1024.
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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.

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Model for improved prescribing, with the patient and provider sitting on the same side of the screen, jointly making treatment decisions with support from the 3 databases. USPDI indicates US Pharmacopeia Drug Information; CDC STD Rx, Centers for Disease Control and Prevention sexually transmitted disease treatment.

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