PRODIGY (PROject prescribing rationally with Decision-support In General-practice studY) is a major national initiative to develop and evaluate computerized prescribing decision support systems for UK general practice, short GP.

PRODIGY is a prescribing decision support tool that encourages evidence-based cost-effective GP prescribing. It provides decision support to a GP immediately following diagnosis, by presenting clinical advice and therapeutic recommendations. PRODIGY also presents non-drug treatments and contains over 350 patient information leaflets (PIL). Each PIL contains general information about the associated disease in layman terms. GPs use PRODIGY on existing practice computer systems (AAH Meditel System 5), during a consultation. When a diagnosis (Read Code) is entered into the record, the software checks to see if there is a suitable PRODIGY clinical recommendation available. If there is, then the GP is informed and has the option of exploring that recommendation or ignoring it. Exploration will offer scenarios, therapy groups and therapy details resulting in evidence-based prescribing and the availability of PILs. The GP can add his own drugs and information as well. Background information on the rationale behind the options is always available.

Evaluation: PRODIGY has been developed and evaluated in two phases, PRODIGY I was piloted in 137 practices from October 1995 to May 1996. PRODIGY II, the improved version, was piloted in 183 practices from April 1997 until October 1997. During the second phase of PRODIGY research, the structure of PRODIGY guidance was developed, as were the authoring methods. Each guideline now includes up to 25 different prescriptions in each scenario for a particular patient, so that the GP user has a wider choice of therapies than was available in the first phase. There were highly significant improvements in usage of PRODIGY and PILs by GPs during PRODIGY phase II compared to phase I. Although 65% of the GP users believed some further work needed to be done on the system, 95% indicated a desire to continue to use PRODIGY.

Nation-wide implementation of a decision support system in general practice in Great Britain.

In 1995 the English National Health Service Executive commissioned the Sowerby Centre for Health Informatics at Newcastle University to develop and evaluate a prototype system to support UK general practice with guidance on therapeutic actions, initially covering prescribing. The research team developed the system specification and knowledge base; the five largest UK general practice system suppliers (AAH Meditel, EMIS, Aremissoft, In Practice Systems and Torex) wrote and integrated the software into their clinical systems. Following the success, the Department of Health announced plans for a nation-wide rollout of PRODIGY to all GP in November 1998. It is widely expected to become a mandatory requirement for all GP systems from 2000 onwards.

or email prodigy-enquiries@shin.ncl.ac.uk