title: Recommendations to improve the usability of drug-drug interaction clinical decision support alerts.
abstract: OBJECTIVE
  To establish preferred strategies for presenting drug-drug interaction (DDI) clinical decision support alerts.
  
  
  METHODS
  A DDI Clinical Decision Support Conference Series included a workgroup consisting of 24 clinical, usability, and informatics experts representing academia, health information technology (IT) vendors, healthcare organizations, and the Office of the National Coordinator for Health IT. Workgroup members met via web-based meetings 12 times from January 2013 to February 2014, and two in-person meetings to reach consensus on recommendations to improve decision support for DDIs. We addressed three key questions: (1) what, how, where, and when do we display DDI decision support? (2) should presentation of DDI decision support vary by clinicians? and (3) how should effectiveness of DDI decision support be measured?
  
  
  RESULTS
  Our recommendations include the consistent use of terminology, visual cues, minimal text, formatting, content, and reporting standards to facilitate usability. All clinicians involved in the medication use process should be able to view DDI alerts and actions by other clinicians. Override rates are common but may not be a good measure of effectiveness.
  
  
  CONCLUSIONS
  Seven core elements should be included with DDI decision support. DDI information should be presented to all clinicians. Finally, in their current form, override rates have limited capability to evaluate alert effectiveness.
  
  
  CONCLUSIONS
  DDI clinical decision support alerts need major improvements. We provide recommendations for healthcare organizations and IT vendors to improve the clinician interface of DDI alerts, with the aim of reducing alert fatigue and improving patient safety.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Payne
authors.affiliation: Department of Pharmacy Practice & Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Hines
authors.affiliation: Information Technology, Sentara Healthcare, Virginia Beach, VA, USA.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Chan
authors.affiliation: Department of Pharmacy Services, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Hartman
authors.affiliation: Clinical Editorial, FDB (First Databank, Inc.), San Francisco, CA, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Kapusnik-Uner
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center; Regenstrief Institute, Inc. Indianapolis, IN USA; and Purdue University College of Pharmacy, West Lafayette, IN USA.
authors.forename: Alissa L
authors.initials: AL
authors.lastname: Russ
authors.affiliation: Department of Pharmacy, The University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Chaffee
authors.affiliation: Clinical Solutions, Pharmacy OneSource, Boston, MA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Hartman
authors.affiliation: PeaceHealth St. John Medical Center, Longview WA, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Tamis
authors.affiliation: At the time of this study was with Pharmacy Services, PeaceHealth Southwest Medical Center, Vancouver, WA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Galbreth
authors.affiliation: Internal Medicine, Department of Veterans Affairs (VA), Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Glassman
authors.affiliation: Medical Informatics, Wolters Kluwer Health - Clinical Solutions, Newton, MA, USA/San Diego, CA, USA.
authors.forename: Shobha
authors.initials: S
authors.lastname: Phansalkar
authors.affiliation: Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: van der Sijs
authors.affiliation: College of Nursing, The University of Arizona, Tucson, AZ, USA.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Gephart
authors.affiliation: Pharmacy, Epic, Verona, WI, USA.
authors.forename: Gordon
authors.initials: G
authors.lastname: Mann
authors.affiliation: Medical Informatics, Wolters Kluwer Health - Clinical Solutions, Newton, MA, USA/San Diego, CA, USA.
authors.forename: Howard R
authors.initials: HR
authors.lastname: Strasberg
authors.affiliation: Center for Health Outcomes & PharmacoEconomic Research, The University of Arizona College of Pharmacy, Tucson, AZ, USA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Grizzle
authors.affiliation: Department of Pharmacy Practice & Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Brown
authors.affiliation: Interoperability Informatics, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Gilad J
authors.initials: GJ
authors.lastname: Kuperman
authors.affiliation: Editorial Systems, Gold Standard Drug Databases/Elsevier, Tampa, FL, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Steiner
authors.affiliation: Information Technology and Services, Cerner Corporation, Kansas City, MO, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sullins
authors.affiliation: Information Technology and Services, Cerner Corporation, Kansas City, MO, USA.
authors.forename: Hugh
authors.initials: H
authors.lastname: Ryan
authors.affiliation: Office of Clinical Quality and Safety, Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, DC, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Wittie
authors.affiliation: Department of Pharmacy Practice & Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA malone@pharmacy.arizona.edu.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Malone
mesh_terms: D032921:Consensus; D004347:Drug Interactions; D004360:Drug Therapy, Computer-Assisted; D006801:Humans; D050316:Medical Order Entry Systems / Q000592:standards*
keywords: CPOE (up to 5); alerts; clinical decision support; drug interactions; usability
references.citation: Pharmacotherapy. 2012 Apr;32(4):304-13
references.pmid: 22461120
references.citation: BMC Med Inform Decis Mak. 2013 Oct 01;13:111
references.pmid: 24083548
references.citation: Eur J Clin Pharmacol. 2014 Mar;70(3):313-8
references.pmid: 24306496
references.citation: Am J Health Syst Pharm. 2009 Jan 1;66(1):38-44
references.pmid: 19106343
references.citation: J Am Pharm Assoc (Wash). 2001 Mar-Apr;41(2):161-5
references.pmid: 11297327
references.citation: Cochrane Database Syst Rev. 2014 Apr 29;(4):CD007768
references.pmid: 24777444
references.citation: Arch Intern Med. 2009 Sep 28;169(17):1627-32
references.pmid: 19786683
references.citation: BMC Med Inform Decis Mak. 2013 Jul 01;13:69
references.pmid: 23816138
references.citation: Int J Med Inform. 2013 Jun;82(6):492-503
references.pmid: 23490305
references.citation: J Am Med Inform Assoc. 2011 Jul-Aug;18(4):479-84
references.pmid: 21571746
references.citation: NCHS Data Brief. 2014 Jan;(143):1-8
references.pmid: 24439138
references.citation: BMC Med Inform Decis Mak. 2012 Oct 02;12:111
references.pmid: 23031275
references.citation: J Am Med Inform Assoc. 2010 Sep-Oct;17(5):493-501
references.pmid: 20819851
references.citation: J Am Med Inform Assoc. 2014 Oct;21(e2):e287-96
references.pmid: 24668841
references.citation: Drug Saf. 2005;28(12):1131-9
references.pmid: 16329715
references.citation: J Gen Intern Med. 2012 Dec;27(12):1582-4
references.pmid: 23129158
references.citation: J Am Pharm Assoc (2003). 2006 Mar-Apr;46(2):148-53
references.pmid: 16602224
references.citation: J Clin Pharm Ther. 2002 Oct;27(5):311-2
references.pmid: 12383130
references.citation: BMC Med Inform Decis Mak. 2011 May 25;11:35
references.pmid: 21612623
references.citation: J Am Med Inform Assoc. 2007 Jan-Feb;14(1):56-64
references.pmid: 17068346
references.citation: Int J Med Inform. 2014 Apr;83(4):285-91
references.pmid: 24484781
references.citation: Risk Anal. 1999 Jun;19(3):391-400
references.pmid: 10765412
references.citation: Proc AMIA Annu Fall Symp. 1997;:749-53
references.pmid: 9357725
references.citation: J Am Med Inform Assoc. 2009 Nov-Dec;16(6):816-25
references.pmid: 19717798
references.citation: J Am Med Inform Assoc. 2001 Jul-Aug;8(4):299-308
references.pmid: 11418536
references.citation: J Am Pharm Assoc (2003). 2013 Jan-Feb;53(1):39-45
references.pmid: 23636154
references.citation: AMIA Annu Symp Proc. 2009 Nov 14;2009:548-52
references.pmid: 20351915
references.citation: AMIA Annu Symp Proc. 2011;2011:339-48
references.pmid: 22195086
references.citation: Expert Opin Drug Saf. 2011 Nov;10(6):871-82
references.pmid: 21542665
references.citation: BMC Med Inform Decis Mak. 2013 Dec 05;13:133
references.pmid: 24308799
references.citation: J Biomed Inform. 2012 Dec;45(6):1202-16
references.pmid: 22995208
references.citation: J Am Med Inform Assoc. 2012 May-Jun;19(3):346-52
references.pmid: 21849334
references.citation: Arch Intern Med. 2012 May 14;172(9):731-6
references.pmid: 22782203
references.citation: Int J Med Inform. 2012 Apr;81(4):232-43
references.pmid: 22296761
references.citation: J Am Med Inform Assoc. 2006 Mar-Apr;13(2):138-47
references.pmid: 16357358
references.citation: J Pers Soc Psychol. 1991 Jul;61(1):13-25
references.pmid: 1890583
references.citation: J Am Med Inform Assoc. 2011 Jan-Feb;18(1):32-7
references.pmid: 21131607
references.citation: J Am Med Inform Assoc. 2011 Dec;18 Suppl 1:i62-72
references.pmid: 21946241
references.citation: Pediatrics. 2013 Jun;131(6):e1970-3
references.pmid: 23713099
references.citation: Am J Public Health. 2003 Apr;93(4):635-41
references.pmid: 12660210
references.citation: N Engl J Med. 2010 Dec 23;363(26):2477-81
references.pmid: 21142528
references.citation: J Am Med Inform Assoc. 2014 Oct;21(e2):e332-40
references.pmid: 24780721
references.citation: Am J Manag Care. 2007 Oct;13(10):573-8
references.pmid: 17927462
references.citation: Am J Geriatr Pharmacother. 2011 Dec;9(6):364-77
references.pmid: 22078863
references.citation: Am J Health Syst Pharm. 2013 May 15;70(10):905-9
references.pmid: 23640353
references.citation: J Am Med Inform Assoc. 2009 Jul-Aug;16(4):531-8
references.pmid: 19390110
references.citation: Expert Opin Drug Saf. 2012 Jan;11(1):83-94
references.pmid: 22022824