A systematic review published in March 2026 in the International Journal of Medical Informatics brings together the studies that have added indications to electronic prescribing systems. It found 24, and only one of them looked at prescriptions for all medicines.
What did the review look at?
The authors, Pairman, Chin and Doogue of the University of Otago in Christchurch, New Zealand, searched four databases (Medline, Embase, CINAHL and Scopus) for studies that introduced indication-based prescribing, or prescribing with indications, in an electronic medication management system. From 1,908 abstracts, 24 studies met their criteria.
What did it find?
- Of the 24 studies, 16 focused on antimicrobial medicines and four on blood products. Only one examined prescriptions for all medicines.
- Three studies found better recording of indications, four found prescriptions more appropriate for the recorded indication, two found more deprescribing, and ten found less overuse of antimicrobials and blood products.
- The accuracy of indications was defined and measured in different ways, and the studies varied widely in the changes made and the systems used, which limits how far the results apply elsewhere.
What do the authors recommend?
Agreed international standards to guide system suppliers and consistency in practice, and more standard terms for describing medicine use, so that studies can be compared.
What happened when a hospital made the indication field compulsory?
The same team reported in 2025 on the district hospitals in Christchurch, which in May 2023 made the free-text indication field compulsory for all medicines in their inpatient prescribing system. The share of prescriptions with an indication rose from 29% to 76%, with only a small increase in meaningless entries, but medicine use did not change. The authors conclude that compulsory fields should be combined with improvements in other parts of care (Br J Clin Pharmacol 2025;91(5):1370-81).
What does this mean for clinical indications?
Clinical indications are about adding three or four words to every prescription, for every medicine, saying what it is for. The review shows that most published studies so far have looked at antimicrobials and blood products, and that studies of indications across all medicines are still rare. The General Medical Council already advises doctors to consider including clinical indications on their prescriptions: see what the GMC guidance says.
Reference: Pairman L, Chin P, Doogue M. Indication-based prescribing and prescribing with indications, effects on documentation, medicines use, and clinical outcomes: a systematic review. Int J Med Inform 2026;207:106209 (PubMed).