Clinical Decision Support for Drug-Drug Interactions: Improvement Needed

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This is a review John R. Horn, Karl F. Gumpper, J. Chad Hardy, Patrick J. McDonnell, Shobha Phansalkar, and Cynthia Reilly's (2013) article, Clinical decision support for drug-drug interactions: improvement needed. [1]


Clinical Decision Support (CDS) continues to enhance clinicians’ decision making and workflow. It has solved many adverse drug events in healthcare through the use of medication alerts. One type of alert is drug-drug interaction (DDI). In this article, the authors focus on some of the current issues with DDI and how it can be improved.


Alert fatigue is the most common complaint of users of EHR systems. [1] Physicians override the majority of the alerts presented in the system sometimes even without reading the details on the alert.


The authors discussed a few ways to improve DDI alerts and how to reduce the number of times clinicians overrides these alerts.

  • Better alert consistency in terms of vocabulary, drug class, etc. However, standardizations is very unlikely because different institutions will have different criterias.
  • Alerts should not require an absolute response, but instead should allow the clinician to deal with the alerts according to the patient and other variables.
  • Reduce the number of inadequate alerts.
  • Allow some customization for the clinicians.
  • Ensure CDS are up to date
  • User Interface Improvements for alerts (e.g., placement of the alerts, appropriate keywords to draw attention, & visual indicators)
  • Increase clinicians’ understanding of DDI CDS software through training
  • The software should provide not only the likely time course of the interaction but when and what to monitor for evidence of the interaction. [1]


The authors made very good recommendations for improvements. I completely agree with the fact that the user interface for alerts can be improved. However I felt like some of their recommendations has already been implemented in a lot of the current systems. Another thing that the authors discussed about in this article, is customization. Customization can be a bit challenging in my opinion because if end users are given too much control over what alerts they see, it can be dangerous. On the other hand, having the ability to customize alerts can help reduce the amount of alerts that are not applicable to that clinician’s job role.

Related Articles

Practitioners' Views on Computerized Drug—Drug Interaction Alerts in the VA System


  1. 1.0 1.1 1.2 Horn, J.R., Gumpper, K.F., Hardy, J.C., McDonnell, P.J., Phansalkar, S., Reiley, C., (2013). Creating Clinical Decision Support for Drug-Drug Interactions: Improvement Needed.