title: New Alert Override Codes for the Drug Utilization Review System Derived from Outpatient Prescription Data from a Tertiary Teaching Hospital in Korea.
abstract: OBJECTIVE
  This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution.
  
  
  METHODS
  Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons.
  
  
  RESULTS
  We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for "prescription relating to operation" and "emergency situations." Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: "patient was not taking/will not take the medications involved in the DDI." Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes.
  
  
  CONCLUSIONS
  These new codes will facilitate the use of the drug-drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Chul
authors.initials: C
authors.lastname: Jang
authors.affiliation: Department of Healthcare Management, Eulji University, Seongnam, Korea.
authors.forename: Ki-Bong
authors.initials: KB
authors.lastname: Yoo
authors.affiliation: Department of Public Health and Medical Administration, Dongyang University, Yeongju, Korea.
authors.forename: Woojae
authors.initials: W
authors.lastname: Kim
authors.affiliation: Mibyeong Research Center, Korea Institute of Oriental Medicine, Daejeon, Korea.
authors.forename: Man Young
authors.initials: MY
authors.lastname: Park
authors.affiliation: Department of Nursing, Dongyang University, Yeongju, Korea.
authors.forename: Eun Kyoung
authors.initials: EK
authors.lastname: Ahn
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Rae Woong
authors.initials: RW
authors.lastname: Park
keywords: Clinical Decision Support Systems; Contraindications; Drug Interactions; Drug Utilization Review; Outpatient Care