Clinical Decision Support and Electronic Prescribing Systems: A Time for Responsible Thought and Action

Abstract

Electronic prescribing (e-prescribing) systems can provide computer-based support for the creation, transmission, dispensing, and monitoring of pharmacological therapies. In the United States and other countries, such systems have been documented, under certain conditions, to increase the safety and quality of patient care.1–5 The authors applaud the initial efforts of Teich and colleagues in the Joint Clinical Decision Support Workgroup (Joint CDS WG) to outline e-prescribing desiderata, as reported in this issue of JAMIA by Teich et al.6 Their article is published as an endorsed policy of the American Medical Informatics Association (AMIA). Previously, Bell et al. published an excellent list of desiderata for outpatient e-prescribing and sorted the desiderata into functional categories.7 Subsequently, Wang et al. surveyed e-prescribing vendor systems to determine that existing systems on average met only half the desiderata, with none exceeding 64% fulfillment.8 The recommendations outlined in the tables of the Joint CDS WG provide a useful point of departure for future discussions. Of note, the Joint CDS WG guidelines were developed as a “commissioned work” with externally determined foci, time limitations, and priorities, so that those guidelines do not fully cover all relevant areas. The Joint CDS WG document therefore represents an important first step in an evolving approach to a complex set of problems. The Joint CDS WG recommendations present a scenario of how e-prescribing features might be rolled out. The authors of this commentary would like to supplement, from what we believe is a broader perspective, the focused set of Joint CDS WG recommendations. The Joint CDS WG proposal has several strengths, including the recommendations that the United States should develop and promote shareable standards for e-prescribing and related decision support systems, a consensus should be developed on how to implement and evaluate decision support systems, and …