On-Line,Real-Time Drug Utilization Review: Evolution toward Decision Support

On-line real-time drug utilization review (ORDUR) in general, and prospective drug utilization review, specifically, have been embraced conceptually by the health care industry. To date, ORDUR has focused on the avoidance of harmful drug combinations or misuse of medications as a means of both reducing costs and preventing adverse health outcomes. Health care organizations that are responsible for prescription drug benefit programs are able to demonstrate some cost savings as a direct result of implementing ORDUR, which has contributed to its wide acceptance. The limiting factor for the effectiveness of clinical algorithms used in such applications is the type of information available via community pharmacy information systems. Thus, in order to improve the effectiveness of ORDUR screening, additional information is required. Specifically, diagnostic information normally found in patients' medical records is a primary requirement for enhancing the integrity and accuracy of current clinical algorithms. In the near future, decision support tools are likely to be developed which should optimize the usefulness of this information once it becomes available. Before ORDUR can evolve into an integral piece of the pharmacotherapeutic process, in the form of on-line, real-time decision support (ORDS), such additional decision support tools will be necessary.