Research group, Clinical Pharmacology & Clinical Pharmacy (KFAR), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
The Centre for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Partners Healthcare, Boston, MA, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA, USA.
Int J Med Inform. 2018 Mar;111:165-171. doi: 10.1016/j.ijmedinf.2017.12.027. Epub 2018 Jan 9.
To investigate whether alert warnings for high-priority and low-priority drug-drug interactions (DDIs) were present in five international electronic health record (EHR) systems, to compare and contrast the severity level assigned to them, and to establish the proportion of alerts that were overridden.
We conducted a comparative, retrospective, multinational study using a convenience sample of 5 EHRs from the U.S., U.K., Republic of Korea and Belgium.
Of the 15 previously defined, high-priority, class-based DDIs, alert warnings were found to exist for 11 in both the Korean and UK systems, 9 in the Belgian system, and all 15 in the two US systems. The specific combinations that were included in these class-based DDIs varied considerably in number, type and level of severity amongst systems. Alerts were only active for 8.4% (52/619) and 52.4% (111/212) of the specific drug-drug combinations contained in the Belgian and UK systems, respectively. Hard stops (not possible to override) existed in the US and UK systems only. The override rates for high-priority alerts requiring provider action ranged from 56.7% to 83.3%. Of the 33 previously defined low-priority DDIs, active alerts existed only in the US systems, for three class-based DDIs. The majority were non-interruptive.
Alert warnings existed for most of the high-priority DDIs in the different EHRs but overriding them was easy in most of the systems. In addition to validating the high- and low-priority DDIs, this study reported a lack of standardization in DDI levels across different international knowledge bases.
调查五个国际电子健康记录（EHR）系统中是否存在高优先级和低优先级药物相互作用（DDI）的警报警告，比较和对比它们分配的严重程度，并确定被覆盖的警报的比例。
我们使用来自美国、英国、韩国和比利时的五个 EHR 的便利样本进行了一项比较、回顾性、多国研究。
在之前定义的 15 种高优先级、基于类别的 DDI 中，发现在韩国和英国系统中存在警报警告的有 11 种，在比利时系统中有 9 种，在两个美国系统中有全部 15 种。这些基于类别的 DDI 中包含的特定组合在数量、类型和严重程度方面在系统之间存在很大差异。在比利时和英国系统中，只有 8.4%（52/619）和 52.4%（111/212）的特定药物-药物组合中的警报处于活动状态。仅在美国和英国系统中存在硬停止（无法覆盖）。需要提供者采取行动的高优先级警报的覆盖率范围为 56.7%至 83.3%。在之前定义的 33 种低优先级 DDI 中，只有美国系统中存在活动警报，针对三种基于类别的 DDI。大多数是非中断性的。
在不同的 EHR 中，大多数高优先级 DDI 都存在警报警告，但在大多数系统中，覆盖它们很容易。除了验证高优先级和低优先级 DDI 外，本研究还报告了不同国际知识库中 DDI 水平缺乏标准化的情况。
