Criteria for assessing high-priority drug-drug interactions for clinical decision support in electronic health records

BMC Medical Informatics and Decision Making

Research Article

Melissa Czochanski¹  Eileen Yoshida¹  John Doole¹  Amrita Desai¹  Alisha D Tucker¹  Shobha Phansalkar²  Blackford Middleton²  David W Bates²  Douglas Bell³  Anish Choksi⁴ 

[1] Partners Healthcare Systems, Inc, 93 Worcester Street, 2nd Floor, Wellesley Gateway, 02481, Wellesley, MA, USA;Partners Healthcare Systems, Inc, 93 Worcester Street, 2nd Floor, Wellesley Gateway, 02481, Wellesley, MA, USA;Division of General Medicine and Primary Care, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont Street, 02120, Boston, MA, USA;RAND, 1776 Main Street, 90401, Santa Monica, CA, USA;Department of Medicine, University of California Los Angeles, 405 Hilgard Avenue, 90095, Los Angeles, CA, USA;University of Chicago School of Medicine, 60637, Chicago, IL, USA;

关键词: Clinical decision support;    Drug-drug interaction;    Medication-related decision support system;    Electronic health record;    Alerts;   

DOI  :  10.1186/1472-6947-13-65

 received in 2012-08-17, accepted in 2013-05-17,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundHigh override rates for drug-drug interaction (DDI) alerts in electronic health records (EHRs) result in the potentially dangerous consequence of providers ignoring clinically significant alerts. Lack of uniformity of criteria for determining the severity or validity of these interactions often results in discrepancies in how these are evaluated. The purpose of this study was to identify a set of criteria for assessing DDIs that should be used for the generation of clinical decision support (CDS) alerts in EHRs.MethodsWe conducted a 20-year systematic literature review of MEDLINE and EMBASE to identify characteristics of high-priority DDIs. These criteria were validated by an expert panel consisting of medication knowledge base vendors, EHR vendors, in-house knowledge base developers from academic medical centers, and both federal and private agencies involved in the regulation of medication use.ResultsForty-four articles met the inclusion criteria for assessing characteristics of high-priority DDIs. The panel considered five criteria to be most important when assessing an interaction- Severity, Probability, Clinical Implications of the interaction, Patient characteristics, and the Evidence supporting the interaction. In addition, the panel identified barriers and considerations for being able to utilize these criteria in medication knowledge bases used by EHRs.ConclusionsA multi-dimensional approach is needed to understanding the importance of an interaction for inclusion in medication knowledge bases for the purpose of CDS alerting. The criteria identified in this study can serve as a first step towards a uniform approach in assessing which interactions are critical and warrant interruption of a provider’s workflow.

【 授权许可】

CC BY   
© Phansalkar et al.; licensee BioMed Central Ltd. 2013