On-line computer pharmacokinetics program: lessons learned from its failure.

Decision support computer technology (DST) embedded in laboratory or hospital information systems has great potential but has rarely been successful. Through studying a pharmacokinetic program that automatically extracted data without requiring manual data entry, we have identified several barriers to the successful implementation of DST. Manual data entry is a major barrier, but so is the entry of erroneous data such as heights, weights, drug dosing times, and specimen collection times. In such a system, unanticipated changed modes of clinical practice and software changes in the system's component modules can be incompatible with the decision-support program, necessitating software revisions. We also noted that clinicians increased their ordering of laboratory tests and changes in drug doses but without improvement in patients' outcomes. This suggests that information output from the program can be misinterpreted by clinicians. In summary, DST programs should be validated in an actual working environment.