Quality of prescribing decision support in primary care: still a work in progress

Farah Magrabi and Enrico W Coiera
Med J Aust 2009; 190 (5): . || doi: 10.5694/j.1326-5377.2009.tb02378.x
Published online: 2 March 2009

Clinical software governance and real-world testing involving users are urgently needed

In this issue of the Journal, a study from the National Prescribing Service (NPS) examines the quality of drug interaction alerts generated by nine clinical software systems currently used by general practitioners and pharmacists in Australia for prescribing or dispensing medications (Sweidan et al).1 The findings will come as no surprise to those who have repeatedly expressed concern about the shortcomings of clinical decision support software.2,3 Only half of the six prescribing systems examined by the NPS alerted users to all 20 of the major drug–drug interactions tested, which can occur with commonly used drugs and with the potential to trigger serious adverse reactions. The best of the three dispensing systems detected 19 of these drug interactions. Yet Australian GPs are heavily reliant on such software alerts: 88% of respondents to a recent national survey reported relying on their prescribing software to check for drug–drug interactions.4 Any failure of decision support systems to provide adequate drug safety alerts is thus likely to pose risks to patient safety.

  • Centre for Health Informatics, University of New South Wales, Sydney, NSW.


  • 1. Sweidan M, Reeve JF, Brien JE, et al. Quality of drug interaction alerts in prescribing and dispensing software. <eMJA full text>
  • 2. Ahearn MD, Kerr SJ. General practitioners’ perceptions of the pharmaceutical decision-support tools in their prescribing software. <eMJA full text>
  • 3. Coiera E, Westbrook J, Wyatt J. The safety and quality of decision support systems. Yearb Med Inform 2006; 45 Suppl 1: 20-25.
  • 4. McInnes DK, Saltman DC, Kidd MR. General practitioners’ use of computers for prescribing and electronic health records: results from a national survey. Med J Aust 2006; 185: 88-91. <MJA full text>
  • 5. van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc 2006; 13: 138-147.
  • 6. Coiera EW, Westbrook JI. Should clinical software be regulated [editorial]? Med J Aust 2006; 184: 600-601. <MJA full text>
  • 7. Certification Commission for Healthcare Information Technology [website]. (accessed Nov 2008).
  • 8. NHS Connecting for Health Initiative. Hazard Framework guidelines highlight need for ePrescribing safety features. 23 Sep 2008. (accessed Nov 2008).
  • 9. Fernando B, Savelyich BS, Avery AJ, et al. Prescribing safety features of general practice computer systems: evaluation using simulated test cases. BMJ 2004; 328: 1171-1172.
  • 10. Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc 2004; 11: 104-112.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.