This topic focuses on steps that surround prescription of a selected drug. Clinical steps that will have preceded drug (treatment) selection are outlined on PrescribingProcessClinical. Requirements for various reports (including "Prescriptions" by country) are at PrescribingReports.

++ Binding the clinical record to a drug database

The first problem is how to represent prescription data in the clinical database. We encounter the same problem as identities: there is no simple unique way of identifying drugs.

The database must therefore have a high degree of redundancy in this design.

+ prescribed drugs table

This is a descendent of clin_root_item so is already linked to patient, episode, and encounter

We also need a second table to hold the generic contents

++ Drug database

We should use an XMLRPC interface. Spec is here. This requires separate "drivers" for each database type. Because the API is geared towards drugref, some changes may be required to accomodate other databases.

The "reference" information is available through separate drug information browsers, each targeted to a specific database, it accepts search queries from the prescribing widget (when the user clicks on the "drug information" button) and displays the matching monograph(s).

Hilmar Berger has already written a (?? working ??) browser for the German AMIS database.

++ Localisation

Prescribing has some aspects which are very locale specific.

In Australia, some drugs are "on Authority", from our persective, this means displaying a (specific for that drug) text string in a dialogue box when certain drugs are prescribed, the doctor rings the authority office, and receives an authority code, which is typed into a text field on the dialogue box, then printed on the script.

(insert description of example of a regulatory requirement from germany)

We may end up just having to fork the prescribing widget for each country, using a common codebase, but should we consider a single widget which calls a "localisation" plugin at various key points in the prescrbing process?

++ Misc notes option to "stop" medication in addition to delete, so delete is only used if medication prescribed in error, but stopped medication could show up as Rx with letters crossed through or in a different colour and date visible so you don't have to search through encounter notes to figure out when a particular med was stopped - clean up medications so you don't have a dozen amoxicillins or dexamethasones to hunt through to find the particular dose and formulation (e.g. tab vs suspension) you want - clean up Rx syntax, especially for prn meds - ability to add instructions re augmenting or tapering dose - i.e. one prescription then a "followed by" and a second prescriptions, useful for SSRIs, smoking cessation, ACE-inhibitors - speaking of ACE-inhibitors, combo drugs like Altace-HCT come in several different dose combinations of the two components, but some EMRs don't show you that distinction. Altace-HCT is listed several times and you have to choose a drug then highlight components and see if you've picked the right one, or just edit the prescription manually as I usually do, but is inefficient.