Format

Send to

Choose Destination
J Am Med Inform Assoc. 2017 Mar 1;24(2):331-338. doi: 10.1093/jamia/ocw114.

Variation in high-priority drug-drug interaction alerts across institutions and electronic health records.

Author information

1
Partners Healthcare, Wellesley, Massachusetts, USA.
2
School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA.
3
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
4
Massachusetts College of Pharmacy and Health Science, Boston, Massachusetts, USA.
5
Memorial Hermann Health System, Houston, USA.
6
WVP Health Authority, Salem, Oregon, USA.
7
Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
8
The Permanente Federation, Portland, Oregon, USA.
9
Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
10
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA.
11
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
12
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
13
Women's Health Specialists of Saint Louis, Saint Louis, Missouri, USA.
14
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
15
Department of Internal Medicine, Holy Spirit Hospital - A Geisinger Affiliate, Camp Hill, Pennsylvania, USA.
16
University of Texas Houston Medical School, Houston, Texas, USA.
17
Hospital Corporation of America Gulf Coast Division, Houston, Texas, USA.
18
School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.

Abstract

Objective:

The United States Office of the National Coordinator for Health Information Technology sponsored the development of a "high-priority" list of drug-drug interactions (DDIs) to be used for clinical decision support. We assessed current adoption of this list and current alerting practice for these DDIs with regard to alert implementation (presence or absence of an alert) and display (alert appearance as interruptive or passive).

Materials and methods:

We conducted evaluations of electronic health records (EHRs) at a convenience sample of health care organizations across the United States using a standardized testing protocol with simulated orders.

Results:

Evaluations of 19 systems were conducted at 13 sites using 14 different EHRs. Across systems, 69% of the high-priority DDI pairs produced alerts. Implementation and display of the DDI alerts tested varied between systems, even when the same EHR vendor was used. Across the drug pairs evaluated, implementation and display of DDI alerts differed, ranging from 27% (4/15) to 93% (14/15) implementation.

Discussion:

Currently, there is no standard of care covering which DDI alerts to implement or how to display them to providers. Opportunities to improve DDI alerting include using differential displays based on DDI severity, establishing improved lists of clinically significant DDIs, and thoroughly reviewing organizational implementation decisions regarding DDIs.

Conclusion:

DDI alerting is clinically important but not standardized. There is significant room for improvement and standardization around evidence-based DDIs.

KEYWORDS:

clinical decision support; drug-drug interactions; electronic health records

PMID:
27570216
PMCID:
PMC5391726
DOI:
10.1093/jamia/ocw114
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center