Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region--Bridging the gap between knowledge and practice.

INTRODUCTION: Stockholm County Council is the largest health care provider in Sweden with an annual budget of US$ 5 billion and catering the needs of a metropolitan population of 2 million people. About 10% of health care costs are used on drugs. In 1996 Stockholm County Council decided to address the main problems associated with the process and the quality of drug prescribing. METHODS: A multiyear strategy was designed, including the establishment of a strong evidence-based organisation, Drug and Therapeutics Committees and editorial resources to adapt information to the IT-media and the development of the IT-architecture. The development and implementation of computerized tools such as a physician drug order entry system including decision support, a drug information website and electronic transmission of prescriptions were started in 1996. RESULTS: The implementation was slow at the point-of-care units. It took about 6 years before the implementation process gained speed. In September 2005 almost 1000 doctors could use the decision support system for prescribing drugs and more than 70% of all prescriptions were transmitted electronically in our region. CONCLUSIONS: The work with the strategy has shown that improvements in drug use can be accomplished by providing access to simple, rapid and safe electronic tools, but the information provided has to be associated with well-recognized regional and national expert organisations.

Janus computerised prescribing system provides pharmacological knowledge at point of care - design, development and proof of concept.

OBJECTIVE: To develop and verify proof of concept for a user-defined prescribing system with decision support based on one single database consisting of several pharmacological sources. METHODS: A multidisciplinary working group within the framework of a two-phase project developed the tool. A small-scale pilot study for proof of concept was carried out in an outpatient neurological polyclinic where four experienced physicians used the tool in patient care on a daily basis. RESULTS: Automatically generated functions, such as recommended drugs, alerts for interactions, alerts for drug therapy during pregnancy and breast-feeding and a search tool for adverse drug effects, were quickly adopted into the daily outpatient working regime. Functions such as treatment strategies and a link to a producer independent website were less frequently used but still rated as useful and educational. CONCLUSION: Searches for information that can be concentrated in one system saves time. Alerts inevitably draw physicians' attention to the information. Instant availability to drug recommendations in a computerised prescribing system such as Janus should increase adherence to recommendations, but this needs to be evaluated systematically. Small-scale pilot studies such as the one reported here have been shown to be invaluable in providing the theoretical basis for implementation of the system and for gaining an understanding of the complex change processes involved. Small-scale projects can therefore provided a base for further development and broader implementation of pharmacological tools and services.