[seanwoods]

One problem with most pharmacy dictionaries (e.g. First DataBank) is that it's optimized for pharmacists, not physicians. The docs want to say "give ${x} units of substance ${y}" but they can't do that because their lists are all in dosage forms. Something as simple as tylenol comes in a dizzying array of varieties and often those are presented directly to the user. You can mitigate this problem somewhat by building favorites but the minute the doc wants to order something unconventional they get sucked into the medication cattle shoot again.

[floatrock]

You're defining "unconventional" from the point of view of the pharmacist. The doc's would say the pharmacist is being too restrictive.

I think the previous comment had it closer:

> but doctors and nurses aren't data entry specialists: for the most part, they... encode all the information ("Ampicillin 5mg three times daily") as free text in the medication's "Description" field.

When I worked in the field, the user interviews we did said that basically that doctors don't have time to flip through all the menus and dropdowns. Part of it is the ego that comes with a decade of med school, but part of it is that it IS legitimately faster to scrawl "Ampicillin 5mg three times daily" (or some days "5mg Amp 3x daily") on a piece of paper and move on to the next crisis.

This is the part of medicine that could benefit from the silicon valley consumer-centric design mentality. It's not that hard to build something prettier than the average piece of enterprise software. The real test is can your responsive and reactive UI make something that has the accuracy benefits of being electronic while still faster than scrawling "5mg Amp 3x daily" on paper so your user can move on to the next patient.

[seanwoods]

I am defining "unconventional" from the point of view of the physician...when compared with the common medications he/she prescribes. An outlier, in other words. Generally in a setting like the Emergency Department, which is where I developed products for 7 years, the docs only describe 20-30 meds 90% of the time. Other specialties, like pain medicine, are similar. For those we build a pre-selected set of favorite meds that they could just click.

The doc would say the pharmacist is not being restrictive enough because the doc has to wade through so many permutations of what is medically the same med, or has to sift through medication forms that he/she has no use for.

From the pharmacist's perspective I want a _complete_ database so I can record with very granular accuracy what the order was. Also, the pharmacy database has things like ingredients in it which it factors into allergy and interaction checking.

I agree with your other points, though. Free text entry is faster - especially if you have voice recognition.

The way to design med lookups, in my opinion, is to have a dropdown for the pharmaceutical substance the physician wants, then the dose, then an optional drop-down for the form (tab, injection, suppository, whatever).

A suitable medication form would need to be found between what's medically indicated, what the pharmacist is okay with, and what the hospital has in stock - ideally in a dispensing machine at the point of care.