title: Criteria for assessing high-priority drug-drug interactions for clinical decision support in electronic health records.
abstract: BACKGROUND
  High 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Forty-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.
  
  
  CONCLUSIONS
  A 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.
authors.affiliation: Partners Healthcare Systems, Inc, Wellesley, MA 02481, USA. sphansalkar@partners.org
authors.forename: Shobha
authors.initials: S
authors.lastname: Phansalkar
authors.forename: Amrita
authors.initials: A
authors.lastname: Desai
authors.forename: Anish
authors.initials: A
authors.lastname: Choksi
authors.forename: Eileen
authors.initials: E
authors.lastname: Yoshida
authors.forename: John
authors.initials: J
authors.lastname: Doole
authors.forename: Melissa
authors.initials: M
authors.lastname: Czochanski
authors.forename: Alisha D
authors.initials: AD
authors.lastname: Tucker
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
authors.forename: Douglas
authors.initials: D
authors.lastname: Bell
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D020000:Decision Support Systems, Clinical / Q000592:standards*; D004347:Drug Interactions; D057286:Electronic Health Records / Q000592:standards*; D006801:Humans; D051188:Knowledge Bases; D050316:Medical Order Entry Systems / Q000592:standards*; D012015:Reference Standards; D015203:Reproducibility of Results