Customizing clinical decision support to prevent excessive drug–drug interaction alerts

Abstract

The Informatics Interchange column gives readers an opportunity to share their experiences with information technology in pharmacy. AJHP readers are invited to submit their experiences and pertinent lessons-learned related to pharmacy informatics. Topics should focus on the use of information technology in the medication-use process, informatics pearls, informatics education and research, and information technology management. Readers are invited to submit their ideas or articles for the column to ajhp@ashp.org or ASHP, c/o Karl

Drug interaction databases in medical literature: transparency of ownership, funding, classification algorithms, level of documentation, and staff qualifications. A systematic review

“…Legal liability is a special concern as this likely result in a defensive approach in recommendations of clinically irrelevant interactions [27,28]. Such confers alert fatigue and may result in overriding of support systems warnings that may be of clinical consequence [24][25][26]. It is plausible that liability issues be of more concern in open access support systems.…”

“…A US White Paper report on conflicts of interests in drug compendia stressed the importance of transparency with respect to competing interests [23]. Overly conservative approaches and unwarranted extrapolations are likely to affect the designation of DDIs and compromise the everyday clinical utility due to "alert fatigue" [24][25][26]. Specific legal circumstances may also interfere with strict scientific judgment of the available evidence, and such "defensive medicine" approach is counterproductive to the usability of such decision support systems [27,28].…”

Recommendations for Generating, Evaluating, and Implementing Drug‐Drug Interaction Evidence

“…For example, filters can be created to decrease the total number of alerts triggered. Customization of alerting logic to accommodate local preferences and practice patterns is also possible . A simulation study of prescribers' handling of drug safety alerts found that enhanced training for end users combined with more concise warnings and increased alert specificity would be beneficial …”

“…Customization of alerting logic to accommodate local preferences and practice patterns is also possible. 49,50 A simulation study of prescribers' handling of drug safety alerts found that enhanced training for end users combined with more concise warnings and increased alert specificity would be beneficial. 51 Internal methods to categorize and determine the relevance of DDIs for CDS have been developed by various experts and organizations, although a gold standard does not exist.…”

Mind the Gap

“…One described an EHR platform that allows individual users to configure the system according to their needs, with benefits over traditional EHR systems based on established theoretical concepts and research-informed usability guidelines [53]. The second was specific to alert fatigue with CDS and described an effective customization of alerts by engaging experts, reviewing the literature, and reviewing CDS with a different set of experts once established [54]. The final article described recommendations from a panel of experts regarding specific customizations to improve safety and utility in the pediatric setting [55].…”