ArticleJournal of the American Medical Informatics Association : JAMIA2015
Optimization of drug-drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard.
Article in Journal of the American Medical Informatics Association : JAMIA, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 4 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
45 citing papers in PubMed, 4 syntheses or guidelines pooled it, 101 citations in OpenAlex.
- The influence of electronic health record design on usability and medication safety: systematic review.BMC health services research · 2025Pooled it
- Systematic review and narrative synthesis of computerized audit and feedback systems in healthcare.Journal of the American Medical Informatics Association : JAMIA · 2022Pooled it
- Optimizing clinical decision support alerts in electronic medical records: a systematic review of reported strategies adopted by hospitals.Journal of the American Medical Informatics Association : JAMIA · 2021Pooled it
- Medication safety alert fatigue may be reduced via interaction design and clinical role tailoring: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2019Pooled it
- Contraindicated drug-drug interactions and associated adverse drug reactions in an observational cohort study of 4543 paediatric hospitalized patients.British journal of clinical pharmacology · 2026Observational
- Effectiveness of computerised alerts to reduce drug-drug interactions (DDIs) and DDI-related harm in hospitalised patients: a quasi-experimental controlled pre-post study.BMJ quality & safety · 2025Article
- Transitioning Ineffective Medications on Hold Alert from Interruptive to Noninterruptive Alert to Decrease Alert Burden.Applied clinical informatics · 2025Article
- Clinical and economic impact of digital dashboards on hospital inpatient care: a systematic review.JAMIA open · 2025Review
- Facilitators and Barriers to Uptake of Drug-Drug Interaction Alerts: Perspectives of Australian End Users and Managers.Applied clinical informatics · 2025Article
- Design and Implementation of a Dashboard for Drug Interactions Mediated by Cytochromes Using a Health Care Data Warehouse in a University Hospital Center: Development Study.JMIR medical informatics · 2024Article
- Successfully Transitioning an Interruptive Alert into a Noninterruptive Alert for Central Line Dressing Changes in the Neonatal Intensive Care Unit.Applied clinical informatics · 2024Article
- A Geospatial Drug Abuse Risk Assessment and Monitoring Dashboard Tailored for School Students: Development Study With Requirement Analysis and Acceptance Evaluation.JMIR human factors · 2024Article
- Interprofessional Evaluation of a Medication Clinical Decision Support System Prior to Implementation.Applied clinical informatics · 2024Article
- Post-implementation optimization of medication alerts in hospital computerized provider order entry systems: a scoping review.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Optimizing Best Practice Advisory alerts in electronic medical records with a multi-pronged strategy at a tertiary care hospital in Singapore.JAMIA open · 2023Article
- Refining Clinical Phenotypes to Improve Clinical Decision Support and Reduce Alert Fatigue: A Feasibility Study.Applied clinical informatics · 2023Article
- Development of a risk-tailored approach and dashboard for efficient management and monitoring of investigator-initiated trials.BMC medical research methodology · 2023Review
- Use of electronic health record best practice alerts to improve adherence to American Urological Association vesicoureteral reflux guidelines.Pediatric surgery international · 2022Article
- i-CLIMATE: a "clinical climate informatics" action framework to reduce environmental pollution from healthcare.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo develop and evaluate an electronic dashboard of hospital-wide electronic health record medication alerts for an alert fatigue reduction quality improvement project.
methodsWe used visual analytics software to develop the dashboard. We collaborated with the hospital-wide Clinical Decision Support committee to perform three interventions successively deactivating clinically irrelevant drug-drug interaction (DDI) alert rules. We analyzed the impact of the interventions on care providers' and pharmacists' alert and override rates using an interrupted time series framework with piecewise regression.
resultsWe evaluated 2 391 880 medication alerts between January 31, 2011 and January 26, 2014. For pharmacists, the median alert rate prior to the first DDI deactivation was 58.74 alerts/100 orders (IQR 54.98-60.48) and 25.11 alerts/100 orders (IQR 23.45-26.57) following the three interventions (p<0.001). For providers, baseline median alert rate prior to the first round of DDI deactivation was 19.73 alerts/100 orders (IQR 18.66-20.24) and 15.11 alerts/100 orders (IQR 14.44-15.49) following the three interventions (p<0.001). In a subgroup analysis, we observed a decrease in pharmacists' override rates for DDI alerts that were not modified in the system from a median of 93.06 overrides/100 alerts (IQR 91.96-94.33) to 85.68 overrides/100 alerts (IQR 84.29-87.15, p<0.001). The medication serious safety event rate decreased during the study period, and there were no serious safety events reported in association with the deactivated alert rules.
conclusionsAn alert dashboard facilitated safe rapid-cycle reductions in alert burden that were temporally associated with lower pharmacist override rates in a subgroup of DDIs not directly affected by the interventions; meanwhile, the pharmacists' frequency of selecting the 'cancel' option increased. We hypothesize that reducing the alert burden enabled pharmacists to devote more attention to clinically relevant alerts.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.