title: Variation in high-priority drug-drug interaction alerts across institutions and electronic health records.
abstract: The United States Office of the National Coordinator for Health Information Technology sponsored the development of a "high-priority" list of drug-drug interactions (DDIs) to be used for clinical decision support. We assessed current adoption of this list and current alerting practice for these DDIs with regard to alert implementation (presence or absence of an alert) and display (alert appearance as interruptive or passive).
  
  
  
  We conducted evaluations of electronic health records (EHRs) at a convenience sample of health care organizations across the United States using a standardized testing protocol with simulated orders.
  
  
  
  Evaluations of 19 systems were conducted at 13 sites using 14 different EHRs. Across systems, 69% of the high-priority DDI pairs produced alerts. Implementation and display of the DDI alerts tested varied between systems, even when the same EHR vendor was used. Across the drug pairs evaluated, implementation and display of DDI alerts differed, ranging from 27% (4/15) to 93% (14/15) implementation.
  
  
  
  Currently, there is no standard of care covering which DDI alerts to implement or how to display them to providers. Opportunities to improve DDI alerting include using differential displays based on DDI severity, establishing improved lists of clinically significant DDIs, and thoroughly reviewing organizational implementation decisions regarding DDIs.
  
  
  
  DDI alerting is clinically important but not standardized. There is significant room for improvement and standardization around evidence-based DDIs.
authors: Partners Healthcare, Wellesley, Massachusetts, USA.
authors: Dustin S
authors: DS
authors: McEvoy
authors: School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA.
authors: Dean F
authors: DF
authors: Sittig
authors: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Thu-Trang
authors: TT
authors: Hickman
authors: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Skye
authors: S
authors: Aaron
authors: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Angela
authors: A
authors: Ai
authors: Massachusetts College of Pharmacy and Health Science, Boston, Massachusetts, USA.
authors: Mary
authors: M
authors: Amato
authors: Memorial Hermann Health System, Houston, USA.
authors: David W
authors: DW
authors: Bauer
authors: WVP Health Authority, Salem, Oregon, USA.
authors: Gregory M
authors: GM
authors: Fraser
authors: Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
authors: Jeremy
authors: J
authors: Harper
authors: Memorial Hermann Health System, Houston, USA.
authors: Angela
authors: A
authors: Kennemer
authors: The Permanente Federation, Portland, Oregon, USA.
authors: Michael A
authors: MA
authors: Krall
authors: Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors: Christoph U
authors: CU
authors: Lehmann
authors: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA.
authors: Sameer
authors: S
authors: Malhotra
authors: Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.|Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors: Daniel R
authors: DR
authors: Murphy
authors: Women's Health Specialists of Saint Louis, Saint Louis, Missouri, USA.
authors: Brandi
authors: B
authors: O'Kelley
authors: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors: Lipika
authors: L
authors: Samal
authors: Department of Internal Medicine, Holy Spirit Hospital - A Geisinger Affiliate, Camp Hill, Pennsylvania, USA.
authors: Richard
authors: R
authors: Schreiber
authors: Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.|Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors: Hardeep
authors: H
authors: Singh
authors: Memorial Hermann Health System, Houston, USA.|University of Texas Houston Medical School, Houston, Texas, USA.
authors: Eric J
authors: EJ
authors: Thomas
authors: Hospital Corporation of America Gulf Coast Division, Houston, Texas, USA.
authors: Carl V
authors: CV
authors: Vartian
authors: Memorial Hermann Health System, Houston, USA.
authors: Jennifer
authors: J
authors: Westmorland
authors: School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.
authors: Allison B
authors: AB
authors: McCoy
authors: Partners Healthcare, Wellesley, Massachusetts, USA.|Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors: Adam
authors: A
authors: Wright
mesh_terms: D003626:Data Display; D004347:Drug Interactions; D057286:Electronic Health Records / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D050316:Medical Order Entry Systems / Q000592:standards* / Q000706:statistics & numerical data; D016347:Medical Records Systems, Computerized; D014481:United States
keywords: clinical decision support; drug-drug interactions; electronic health records