Variation in high-priority drug-drug interaction alerts across institutions and electronic health records

Dustin S. McEvoy, Dean F. Sittig, Thu Trang Hickman, Skye Aaron, Angela Ai, Mary Amato, David W. Bauer, Gregory M. Fraser, Jeremy Harper, Angela Kennemer, Michael A. Krall, Christoph U. Lehmann, Sameer Malhotra, Daniel R. Murphy, Brandi O'Kelley, Lipika Samal, Richard Schreiber, Hardeep Singh, Eric J. Thomas, Carl V. VartianJennifer Westmorland, Allison B. McCoy, Adam Wright

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


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.

Original languageEnglish (US)
Article numberocw114
Pages (from-to)331-338
Number of pages8
JournalJournal of the American Medical Informatics Association
Issue number2
StatePublished - Mar 1 2017
Externally publishedYes


  • Clinical decision support
  • Drug-drug interactions
  • Electronic health records

ASJC Scopus subject areas

  • Health Informatics


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