Reduced Effectiveness of Interruptive Drug-Drug Interaction Alerts after Conversion to a Commercial Electronic Health Record

Journal of General Internal Medicine
Adam WrightDavid Westfall Bates

Abstract

Drug-drug interaction (DDI) alerts in electronic health records (EHRs) can help prevent adverse drug events, but such alerts are frequently overridden, raising concerns about their clinical usefulness and contribution to alert fatigue. To study the effect of conversion to a commercial EHR on DDI alert and acceptance rates. Two before-and-after studies. 3277 clinicians who received a DDI alert in the outpatient setting. Introduction of a new, commercial EHR and subsequent adjustment of DDI alerting criteria. Alert burden and proportion of alerts accepted. Overall interruptive DDI alert burden increased by a factor of 6 from the legacy EHR to the commercial EHR. The acceptance rate for the most severe alerts fell from 100 to 8.4%, and from 29.3 to 7.5% for medium severity alerts (P < 0.001). After disabling the least severe alerts, total DDI alert burden fell by 50.5%, and acceptance of Tier 1 alerts rose from 9.1 to 12.7% (P < 0.01). Changing from a highly tailored DDI alerting system to a more general one as part of an EHR conversion decreased acceptance of DDI alerts and increased alert burden on users. The decrease in acceptance rates cannot be fully explained by differences in the clinical knowledge base, nor can it be fully...Continue Reading

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Citations

Aug 22, 2020·Yearbook of Medical Informatics·Ivana Jankovic, Jonathan H Chen
Jul 31, 2018·Journal of the American Medical Informatics Association : JAMIA·Adam WrightDean F Sittig
Jul 23, 2019·Journal of the American Medical Informatics Association : JAMIA·Adam WrightDean F Sittig
May 18, 2019·American Society of Clinical Oncology Educational Book·Suzanne ColeKerry Reynolds
Nov 12, 2020·Applied Clinical Informatics·Chunya HuangRichard Schreiber
Sep 17, 2019·Joint Commission Journal on Quality and Patient Safety·David W Bates
Jun 24, 2021·American Journal of Clinical Pathology·Heather M RuffDavid R Peaper
Jun 19, 2021·Diabetes, Obesity & Metabolism·Michael FralickMuhammad Mamdani
Oct 28, 2021·Applied Clinical Informatics·Maya NarayananAnneliese M Schleyer

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