title: Implementing Black Box Warnings (BBWs) in Health Information Systems: An Organizing Taxonomy Identifying Opportunities and Challenges.
abstract: OBJECTIVE
  To develop a practical approach for implementing clinical decision support (CDS) for medication black box warnings (BBWs) into health information systems (HIS).
  
  
  METHODS
  We reviewed all existing medication BBWs and organized them into a taxonomy that identifies opportunities and challenges for implementing CDS for BBWs into HIS.
  
  
  RESULTS
  Of the over 400 BBWs that currently exist, they can be organized into 4 categories with 9 sub-categories based on the types of information contained in the BBWs, who should be notified, and potential actions to that could be taken by the person receiving the BBW. Informatics oriented categories and sub-categories of BBWs include - interactions (13%) (drug-drug (4%) and drug-diagnosis (9%)), testing (21%) (baseline (9%) and on-going (12%)), notifications (29%) (drug prescribers (7%), drug dispensers (2%), drug administrators (9%), patients (10%), and third parties (1%)), and non-actionable (37%). This categorization helps identify BBWs for which CDS can be easily implemented into HIS today (such as drug-drug interaction BBWs), those that cannot be easily implemented into HIS today (such as non-actionable BBWs), and those where advanced and/or integrated HIS need to be in place to implement CDS for BBWs (such a drug dispensers BBWs).
  
  
  CONCLUSIONS
  HIS have the potential to improve patient safety by implementing CDS for BBWs. A key to building CDS for BBWs into HIS is developing a taxonomy to serve as an organizing roadmap for implementation. The informatics oriented BBWs taxonomy presented here identified types of BBWs in which CDS can be implemented easily into HIS currently (a minority of the BBWs) and those types of BBWs where CDS cannot be easily implemented today (a majority of BBWs).
authors.forename: M
authors.initials: M
authors.lastname: Ikezuagu
authors.forename: E
authors.initials: E
authors.lastname: Yang
authors.forename: A
authors.initials: A
authors.lastname: Daghstani
authors.forename: D C
authors.initials: DC
authors.lastname: Kaelber
keywords: BBW; Black box warning; CDS; HIS; clinical decision support; health information systems; patient safety; taxonomy