Objective: 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).Materials and methods: 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.Results: 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.Discussion: 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.Conclusion: DDI alerting is clinically important but not standardized. There is significant room for improvement and standardization around evidence-based DDIs.

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Endemic gentamicin-resistant plasmids derived from 12 species of gram-negative bacilli were analyzed by restriction-endonuclease digestion. These digests showed wide variations in digest patterns, but one or more common fragments were seen in all plasmids studied. Southern blot analysis using one plasmid as a probe revealed that most but not all of these plasmids shared extensive regions of homology. The variance observed in restriction-digest patterns could be accounted for either by introduction of unrelated DNA or by intramolecular events. We conclude that variation in restriction-digest patterns of endemic gentamicin-resistant plasmids is insufficient to establish that the plasmids are not closely related. Variation in molecular structure of closely related, endemic gentamicin-resistant plasmids may be more common than has previously been suspected.

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