Clinical Indications for System Suppliers and Digital Teams

How are indications recorded now?

As free text, and they still are. At present, clinicians add the indication as free text to the directions on the electronic prescription. In EMIS, the free text is stored and offered from a pick list on future issues of prescriptions, for all patients. There is no separate indication field. In 2006, one practice using Vamp Vision built indications into its computerised practice formulary, and FAQ 3 hoped they would become “a standard feature of computerised prescribing packages”.

Other software has used pick lists. A 2014 news item on this site reported that LiMA, used in Department for Work and Pensions work capability assessments, offered a pick list of possible indications, never mandated, with free text always available.

What happens when the field is compulsory?

In one hospital system, recording rose. In Christchurch, New Zealand, the share of medicines with an indication went from 29% to 76% after the field became compulsory, “with only a small increase in ‘rubbish text’”, and no change in medicine use (Pairman et al, 2025).

A 2019 UK study, however, concludes that “systems that force prescribers through mandatory fields to document clinical indications may be counterproductive”. See hospitals.

What does the research say about standards?

That they are needed. A 2026 systematic review of 24 studies, 16 of them on antimicrobials, found that “only one study examined prescriptions for all medicines”, and its authors call for “agreed international standards to guide system vendors” (Pairman et al, 2026).

In 2006, FAQ 7 said indications “should be standardised as much as possible”, and proposed a small Clinical Indications Development Unit to hold a dictionary of indications and work with the British National Formulary.

What features does Dr Masters’ material describe?

• Recommended phrases for the prescriber to pick from a list, not standard phrases added automatically, with the prescriber medicolegally responsible (FAQ 7).
• Room for individual indications, which FAQ 7 says should continue.
• An opt-out phrase, “patient preference no indication”, and a way to tell the pharmacist to leave the indication off the label (FAQ 4, proposed in 2006).
• Safety messages and stop dates, such as “yearly blood pressure check required” for the contraceptive pill (FAQ 5).
• Departure audits: counting repeat items that leave the surgery without a stated indication (FAQ 7).

Can the Sample Directory be built into a system?

It is not offered for that. The Sample Directory was compiled by medical student Mubeen Yousuf at Highfield Surgery, from the surgery’s repeat prescriptions, and the version on this site is dated 2 February 2006. It is an example, not a working directory. It is free for practices and medicines teams to reuse with credit, but Dr Masters has not offered it to system suppliers, because of the medicolegal implications: the prescriber remains responsible for the wording (FAQ 7).

How do prescriptions reach the pharmacy now?

Mostly electronically. In 2024/25, 1.13 billion items, 97% of all items dispensed in England, went through the Electronic Prescription Service (NHSBSA). The indication travels through it as part of the directions (FAQ 15).

How can we work with Dr Masters?

FAQ 7 says working with drug dictionary and computer suppliers “will be vital”. To discuss indication fields, use the contact page.