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August 12, 1998

Barriers to Computerized Prescribing—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(6):516-517. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-6-jac057001

In Reply.—Dr Silverstein's concern about the domination of clinical computing by commercial vendors and corporate information managers is correct. His insights about the poverty of clinical and professional leadership and the "corresponding cultural gap" between IT managers and clinicians likewise are well founded. But these factors represent symptoms more than causes of our present failure to effectively implement computerized prescribing.

As we outlined in Table 2 of our article, progress has been impeded by a panoply of conceptual, technical, and policy barriers. While Silverstein amplifies on one of these barriers, we believe that a deeper understanding of the role and interactions among the 15 inhibitors of progress we identify is necessary to accomplish the goal of using the computer to significantly improve medication use.