RESEARCH ARTICLE Open Access Evaluation of features to support safety and quality in general practice clinical software Michelle Sweidan 1* , Margaret Williamson 1 , James F Reeve 1 , Ken Harvey 2 , Jennifer A O’Neill 3 , Peter Schattner 4 and Teri Snowdon 5 Abstract Background: Electronic prescribing is now the norm in many countries. We wished to find out if clinical software systems used by general practitioners in Australia include features (functional capabilities and other characteristics) that facilitate improved patient safety and care, with a focus on quality use of medicines. Methods: Seven clinical software systems used in general practice were evaluated. Fifty software features that were previously rated as likely to have a high impact on safety and/or quality of care in general practice were tested and are reported here. Results: The range of results for the implementation of 50 features across the 7 clinical software systems was as follows: 17-31 features (34-62%) were fully implemented, 9-13 (18-26%) partially implemented, and 9-20 (18-40%) not implemented. Key findings included: Access to evidence based drug and therapeutic information was limited. Decision support for prescribing was available but varied markedly between systems. During prescribing there was potential for medicine mis-selection in some systems, and linking a medicine with its indication was optional. The definition of ‘current medicines’ versus ‘past medicines’ was not always clear. There were limited resources for patients, and some medicines lists for patients were suboptimal. Results were provided to the software vendors, who were keen to improve their systems. Conclusions: The clinical systems tested lack some of the features expected to support patient safety and quality of care. Standards and certification for clinical software would ensure that safety features are present and that there is a minimum level of clinical functionality that clinicians could expect to find in any system. Background Electronic prescribing (e-prescribing) offers an opportu- nity to improve the quality, safety and efficiency of health care and is now the norm in many countries [1]. There is evidence to show that e-prescribing (often with clinical decision support) is associated with a reduction in medication errors and incomplete or unclear orders, improved drug allergy detection and greater adherence with clinical practice guidelines [2-4]. There are however also reports of unintended negative consequences of e-prescribing, for example unfavourable effects on work- flow and the introduction of new types of errors [5,6]. Software systems for e-prescribing have been available for two decades, however standards and certification processes for these systems have lagged behind develop- ment and use of the software. Currently there is little information for funders or users of these systems to assess how effectively a system supports healthcare safety and quality. In Australia, general practitioners (GPs) have been using clinical software systems that include e-prescribing for more than 15 years, with rapid uptake encouraged by government incentives in the 1990s. These systems have been developed in an unregulated environment, with little evaluation of their impact on clinical practice or health outcomes. We wished to find out if current systems include features that facilitate improved patient safety and care, with a focus on quality use of medi- cines. Quality use of medicines is the judicious, effective and safe use of medicines, and in terms of clinical soft- ware functionality it encompasses the entire medication management process. * Correspondence: msweidan@nps.org.au 1 NPS: Better choices, Better health, Level 7, 418A Elizabeth St, Surry Hills NSW 2010, Australia Full list of author information is available at the end of the article Sweidan et al. BMC Medical Informatics and Decision Making 2011, 11:27 http://www.biomedcentral.com/1472-6947/11/27 © 2011 Sweidan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.