Comparison of three commercial knowledge bases for detection of drug-drug interactions in clinical decision support.
OBJECTIVE
To compare 3 commercial knowledge bases (KBs) used for detection and avoidance of potential drug-drug interactions (DDIs) in clinical practice.


METHODS
Drugs in the DDI tables from First DataBank (FDB), Micromedex, and Multum were mapped to RxNorm. The KBs were compared at the clinical drug, ingredient, and DDI rule levels. The KBs were evaluated against a reference list of highly significant DDIs from the Office of the National Coordinator for Health Information Technology (ONC). The KBs and the ONC list were applied to a prescription data set to simulate their use in clinical decision support.


RESULTS
The KBs contained 1.6 million (FDB), 4.5 million (Micromedex), and 4.8 million (Multum) clinical drug pairs. Altogether, there were 8.6 million unique pairs, of which 79% were found only in 1 KB and 5% in all 3 KBs. However, there was generally more agreement than disagreement in the severity rankings, especially in the contraindicated category. The KBs covered 99.8-99.9% of the alerts of the ONC list and would have generated 25 (FDB), 145 (Micromedex), and 84 (Multum) alerts per 1000 prescriptions.


CONCLUSIONS
The commercial KBs differ considerably in size and quantity of alerts generated. There is less variability in severity ranking of DDIs than suggested by previous studies. All KBs provide very good coverage of the ONC list. More work is needed to standardize the editorial policies and evidence for inclusion of DDIs to reduce variation among knowledge sources and improve relevance. Some DDIs considered contraindicated in all 3 KBs might be possible candidates to add to the ONC list.
National Library of Medicine, Bethesda, MD, USA.
Kin Wah
KW
Fung
First Databank, South San Francisco, CA, USA.
Joan
J
Kapusnik-Uner
Truven Health Analytics, Greenwood Village, CO, USA.
Jean
J
Cunningham
Cerner Multum, Denver, CO, USA.
Stefanie
S
Higby-Baker
National Library of Medicine, Bethesda, MD, USA.
Olivier
O
Bodenreider
D000066491:Clinical Decision-Making; D020000:Decision Support Systems, Clinical; D004347:Drug Interactions; D004360:Drug Therapy, Computer-Assisted; D006801:Humans; D051188:Knowledge Bases; D050316:Medical Order Entry Systems
clinical decision support; commercial knowledge base; computerized physician order entry; drug-drug interaction; prescription decision support