Table 2 Features, requirements, standards, recommendations, and capabilities for the electronic prescribing system

1

Recommendations, requirements, and capabilities

Patient data, Patient selection or identification and data access [10, 13, 14, 16]

Import and export of demographic data and patient identification by the system, Import and export of patient clinical data from / to external sources, manual entry of the patient identification and demographic data when importing information from a practice management system is not possible, merge duplicate records created for the same patient, search for an individual patient by partial name and demographic data contained in the patient record, use the national Individual Healthcare Identifier when it becomes available, records and displays the names and reason for use (if known) of the complementary medicines used by the patient, records and displays a list of illicit/street drugs used by the patient, possibility to change or discontinue a current medication, recording the date, the prescriber name and the reason/s for the change or discontinuation, records and displays clinical information including past medical history, physical examination, undifferentiated problems, provisional or confirmed diagnoses and laboratory and other investigations, and the date of those measurements [16, 24], link and de-link records for patients within the same family, records and displays a patient's pregnancy status or if the patient is currently breastfeeding, records and displays a patient's status as an elite athlete, records, displays and allows updating of the patient's allergies and drug intolerances, records and displays preventative and non-pharmacological management measures in a format for decision support, create a clinical management plan for a patient, in a standard and configurable format that can be automatically populated with data in the patient record [16]

Capability to import patient identity and demographic information from electronic medical records (EMRs) or practice management systems (PMSs) [16], Integration with electronic health record items such as a list of issues and test findings [16, 25, 26], Possibility of access to the relevant electronic prescription if the unique version number in the printed prescription is entered by the pharmacist [15], Data transfer to inpatient, retail, and/or postal pharmacies [13]

2

Features, recommendations, requirements, and capabilities

Drug Selection [13,14,15,16, 18, 24]

Providing information on drug formulations [10, 16, 18, 20, 23, 24], creating a complete list of active drugs [24], registration of drug indications and activation of decision support, quickly and accurately select the most appropriate problem/diagnosis [16], patient support during prescription and active promotion in using the appropriate drugs [24], displays recommended therapeutic options for the selected problem/diagnosis, and differentiates those options that are contraindicated for the patient, define 'order sets' that can be used to easily and quickly manage common problems, immediate access to the meaning of any symbols, icons or special fonts throughout the prescribing process, access to the Therapeutic Goods Administration approved product information† for medicines, access to independent evidence-based information about medication effectiveness and safety, if medications are listed on the Pharmaceutical Benefit Scheme then displays related details including costs [16], providing information on the availability of cheaper drugs and medically appropriate treatment alternatives [17, 24], proposing automatic supply of alternative drugs in case of prescribing non-formulated drugs [23], providing a list of available strengths and forms for the selected medication, providing a list of predefined dosage regimens that may be suitable for the selected medication, providing information on adult doses and children's doses [16], providing age alerts [24], access to dose calculators to assist with dosage calculations e.g. based on weight or age, presentation options for medication selection order to difficult to erroneously select a drug with a similar name, select a medication by drug class, when a brand name is selected, system displays the generic name (active ingredient/s) of the medication, enter medicines that are not on the medication list in the system, in a free text format, specify the length of a course of medicine on the prescription by prescriber, notes on taking or not taking a medicine on day/s of the week, easily re-order a medication from items already on the medication list, creating a prescription that conforms to Pharmaceutical Benefits Scheme† requirements [16], System reminders when drugs are ignored, Ability to write user feedback when prescribing medications (for example, Reason for patient refusing from medication), reminders or alerts by the system when need to ordering medicines [18], Diagnosis-based selection and diagnostics [13], ability to view a list of suitable drugs with the diagnosis [10, 20], Find and choose the name of drug by the user [15], completion of prescription fields (drug name, dose, route, frequency, prescription instructions, duration of treatment, repetitions) [13, 15], select a set of drug orders from the personal list of drugs previously prescribed by a physician, displaying the profile of the drug [15], Using all available data sources, displaying an overview of current drug treatment and medical services Prescription medications shown in the previous six months, Distribution or non-distribution of prescribed medications, medications provided by other doctors, stoppage of treatment, treatment overlap days By clicking on any drug on your physician's list, you may get information on the cost of medicine, emergency visits and hospitalization, observation details of prescription records, and the average cost of prescriptions in the previous six months. Highlighting of medications regarded as potentially problematic for prescription (based on color code intensity), At least one therapeutic symptom from a list of all authorized or recorded symptoms for each prescription medicine, as well as the possibility to enter unlisted or unlabeled symbols via free text input [22], Simplifying the selection and categorization of drug lists into drug groups [17, 20], providing a selection of available and appropriate dosages and forms for a certaindrug [10, 20], ability to view a list of suitable drugs with the diagnosis [10, 20], custom menus of pharmaceutical options and laboratory tests [10, 17], display of drug options should not be influenced by advertising considerations, access to the meaning of any particular symbol or font must be during the prescribing process [10], integration of cost of drug alternatives [17], determining the real cost to the patient for each drug option based on patient prescription insurance coverage, access to evidence of drug effectiveness and potential harm [10], pharmacological vocabulary according to clinical pharmaceutical form RxNorm [20], immediate access of prescribers due to the choice of drug that the system indicates as recommended or preferred for the current patient [10], Import of side effects of medicines [20]

3

Features, requirements, and recommendations

Security, Privacy and administration [10, 14,15,16, 18]

Support systems from compliance with state and national privacy regulations [10, 16], Authentication systems for each user, Easy and secure support of clinical data [16, 18], Possibility of correcting or marking the information in the patient file [16], Secure transfer of sensitive data [18], providing reliable mechanisms for regular timely updates from the vendor, require to unique prescriber identifiers [16], control access privileges for individual users or groups of users [10, 16], record and track provision of data to third parties and receiving informed consent for participation in education, research activities, patient support programs and [16], access and evaluation of data by physicians and researchers [23], 24-h user access to IT support in case of failure, high level of security of anti-theft systems [18], Systems should support compliance with the latest standards of portable law and health insurance accountability for privacy and security, each user must be individually identified in the system and have role-based access privileges [10]

4

Features, requirements, and recommendations

Transparency and accountability [10, 14, 16]

Access to information about the techniques used to produce decision support tools and other aspects that may affect the prescriber's decision-making. Access by the user to information regarding the knowledge source(s) used for decision support and other characteristics that may impact the prescriber's decision-making. User access to information about the financial sponsorship used for decision-making. show pharmaceutical company advertisements Commercial factors should not influence how product selections are shown throughout the medicine choosing process [16]

The disclosure of Conflict of Interest, electronic prescription system vendors' access to resources and methods used to develop clinical decision support rules, including trigger stimuli and other messages [10]

5

Features

Interoperability and communication [18]

The system interfaces with other software applications for managing patient data [16, 24], supports the use of nationally agreed clinical terminologies and coding systems when they become available, transmits data between service providers using a nationally agreed messaging (content) standard, encrypts all messages transmitted between service providers using a nationally agreed standard, imports and exports a variety of file formats associated with a patient record [16], and electrifies all messages transmitted between service providers. creating an Adverse Drug Reactions Advisory Committee report for a patient and enabling electronic delivery of the report, enabling the prescriber to create and customize templates for letters, referrals, and other documents that can be completed with data from the patient record, to ease medication reconciliation, the system enables the doctor to analyze and reconcile a list of suggested drugs from another source with the patient's existing prescription list [16]

6

Features, requirements, recommendations, and capabilities

Monitoring, report, reminder, and renewals, feedback at the prescriber level [10, 13, 14, 16]

Flaging possible under- or overuse of medications by a patient, reminding to the prescriber when a prescription is due or overdue for a patient, during the consultation, reminding to the prescriber of the need for routine or recommended tests associated with certain medications and conditions, reminding to the prescriber when new test results are available for a patient, tracking clinical orders and reminding to the prescriber when a selected test or investigation was ordered in the recent past, reminding to the prescriber when results are abnormal or require action,reminding to the prescriber when patients are due or overdue for testing, including screening [16], accelerate the renewal process of drugs with the ability to send renewal applications electronically and automate the renewal license process [24], displaying cumulative reports of laboratory test results to facilitate trend analysis, and highlights out of range values, providing a facility to monitor results and clinical outcomes related to specific medications, generating predefined reports to enable clinicians to monitor clinical care and audit individual or practice performance, generating reports based on user defined 'query sets' to monitor clinical care and audit individual or practice performance, generating reports on data for individual prescribers or for all the prescribers in the practice, racking a prescriber's history of alerts that were dismissed, providing reports for producing population-based recalls and reminders, for example in population health programs such as immunisation and epidemiological surveillance, flaging a patient for recall for any reason specified by the prescriber, flaging all medications that were changed at the last consultation, alerting to the prescriber when the patient meets the criteria for a Medication Management Review service [16], Announcement of the time period for version extension [26], Notify me of prescriptions generated as a result of my failure to transmit a prescription to the pharmacist [16], Inform the prescriber if the patient has not got the prescription on time or has received it twice [26], Notification from a pharmacy when a prescription is delivered to a patient, Access to test results [16], Outcome commands (for example, for monitoring experiments) [13], facilitate the renewal of previously prescribed drugs by providing a list of current drugs [15], The feedback and Immediate recommendations to resolve potential issues before order activation [23], review of indexes of self-prescribing patterns by prescribers, profile history of ignored alerts by prescribers [10]

7

Features, requirements, recommendations, and capabilities

Infrastructure: Computer equipment, Awareness of physicians and System support, Patient education and information, Usability [10, 13, 14, 16,17,18, 20, 21, 23]

The implement computer systems with enhanced capabilities, [23] emphasize training for new physicians and pharmacists [17, 23], providing comprehensive education to all users and patients [10, 14, 18, 24], patient instructions for using the drug at the appropriate education level [10, 20], software technical support [23], eDialog between the prescriber and the pharmacy [17], computer programs user-friendly [23], Quick and easy use of the system [18], facilitate electronic transfer of prescriptions to pharmacies by sending messages and using cooperative standards, print prescription, providing clinical knowledge to the prescriber, improve work processes [24], Transfer discontinuation orders to pharmacies for distribution, Order to stop and change the drug or dose of the drug along with registering the reason for your decision using the drop-down list, the need for pharmacists to know the symptoms of treatment to improve the distribution safety and the need for patient consultation [15], access to information about prescribed medications for patients based on nationally agreed requirements or recommendations, including displaying and printing a complete list of the patient's current medications, providing 'key counseling points' associated with medications and other management options, access to information about medical conditions for patients, and clinical tools for the prescriber to use with a patient, include or exclude the clinical indication as part of the clinical indication [10, 16]

8

Standards

Standards [20, 22, 24]

Formulary and Benefit Standard [20, 22, 24]

Medication History Standard [22, 24]

Prescription Fill Status Notification [22, 24]

RxNorm Standard [20, 22, 24]

Structured and Codified Sig [20, 22, 24]

Prior authorization standard [22, 24]

9

Recommendations

History of medications/current medications [10, 14]

Prior to selecting a medicine, access to the patient's medical history is required [16, 20], Extraction of patient data for decision support purposes from external sources such as pharmacies, hospitals, laboratories, and electronic health record (EHR) systems, and over-the-counter and alternative medications prescribed by prescribers [16], Patient flushitis observation (flow chart) in conjunction with a medication history and test results [23], Prescribers may get information on prior individual prescriptions, including dosages, prescription dates, and distribution dates [16], Automatic update of the patient's current medication list [23], Possibility of monitoring patients' regular drug usage and medical treatment outcomes [25]

10

Recommendations and requirements

Data transfer and storage [10, 14]

Send prescriptions to the patient elective pharmacy [10, 23], The transfer of clinical data among systems should comply with the latest versions of Level 7 health standards and/or the National Council for Prescription Drug Programs, Systems should use global provider IDs when available, systems should use global patient identifiers if available, support from the integrity of stored or sent data [10], prescription output by JCAHO requirements for drug naming, abbreviations, etc. [20]

11

Recommendations and capabilities

Alerts and other messages to prescribers, and filtering of user-selectable alerts for possible prescription problems and Decision support [13,14,15,16, 18]

Alerts for drug allergies or intolerance and drug interactions [10, 16,17,18,19,20, 23], drug-Test Interference alerts, precautionary alerts for inadvertent errors [20], drug allergy alerts in terms of the food allergies [17, 20], automatic alerts system for contraindications [16, 19, 24], immediate access to the explanation of the rationale of each message [10], distinguish alerts and messages based on patient safety and health concerns from other messages by prescribers, prioritizing safety alerts based on clinical significance [10, 16, 18, 24], suppression of low-priority safety alerts by the prescriber to reduce false positive alerts [10, 23], providing the possibility customization of alerts by the system [16, 18], automated alerts for duplicates therapies and prescriptions [16, 19, 20, 23], system alert for overdose [19, 23], system alert for dose adjustment based on age, sex, weight and kidney and liver function of patients [10, 16, 19, 20], system alert to physician when laboratory test results need to be followed up [10], timely reminders of upcoming monitoring events schedule [20], alerts and messages should indicate the date of the last update of Basic Decision Support Rules [10], The assessment of possible prescribing problems related to drug-contraindications for a particular patient selected, the assessment of possible prescribing problems related to age, medication and age of drug-allergy for selected patient, assessment of possible prescribing problems related to drug interactions for a selected specific patient [13, 15], the assessment of possible prescribing problems related to the repeated therapy for selected patient, the assessment of possible prescribing problems related to the cumulative toxicity for specially selected patient [15], safety alerts base on laboratory medicine (kidney, liver function), safety alerts based on body size, age (child, adult, …), safety alerts based on drug formulation [13], classification of levels of severity of alerts into three levels of complete prohibition, should be avoided if possible, and used with caution, possibility to filter alerts by physicians selectively according to the intensity of alerts, stop alerts that physicians deem clinically irrelevant, display alerts when opening patient records, viewing drug profiles and creating prescriptions [15], alert for fulfillment of patients [13], documenting the reason for ignoring the warning from the drop-down menu by the physician (for example, more benefit than risk) [15], alert for a woman who is pregnant or breastfeeding, alert for patients whose status is recorded as 'elite athlete', the system alert when a prescription for a new or alternative medication is indicated, based on data in the patient record and national best practice guidelines, the system distinguishes alerts and messages based on patient safety, health outcomes, and cost effectiveness concerns from those based on advertisements and other commercial considerations, direct access to the patient data that triggered an alert, suppression of alerts by users, decision support information ​when it was last updated, the system alerts the prescriber when two patients in the system have the same name, during the creation of a new record or when opening an existing record, a preview and reminds the user to confirm that the identity of the patient and the details of prescription, referral or other order prior to electronic transmission, reminder to the user for fulfil regulatory requirements for Pharmaceutical Benefits Scheme† and/or other restricted medications [16], enter additional information about patient medications by the user, The possibility of prescribing unlicensed drugs [18]