Comparison of three commercial knowledge bases for detection of drug-drug interactions in clinical decision support

被引:50
作者
Fung, Kin Wah [1 ]
Kapusnik-Uner, Joan [2 ]
Cunningham, Jean [3 ]
Higby-Baker, Stefanie [4 ]
Bodenreider, Olivier [1 ]
机构
[1] Natl Lib Med, Bldg 38A,Rm9S918,MSC 3826,8600 Rockville Pike, Bethesda, MD 20894 USA
[2] First Databank, San Francisco, CA USA
[3] Truven Hlth Analyt, Greenwood Village, CO USA
[4] Cerner Multum, Denver, CO USA
基金
美国国家卫生研究院;
关键词
drug-drug interaction; commercial knowledge base; clinical decision support; prescription decision support; computerized physician order entry; INTERACTION INFORMATION; INTERACTION SOFTWARE; RECOMMENDATIONS; PRESCRIPTION; MEDICATION; SEVERITY;
D O I
10.1093/jamia/ocx010
中图分类号
TP [自动化技术、计算机技术];
学科分类号
0812 ;
摘要
Objective: To compare 3 commercial knowledge bases (KBs) used for detection and avoidance of potential drug-drug interactions (DDIs) in clinical practice. Methods: Drugs in the DDI tables from First DataBank (FDB), Micromedex, and Multum were mapped to RxNorm. The KBs were compared at the clinical drug, ingredient, and DDI rule levels. The KBs were evaluated against a reference list of highly significant DDIs from the Office of the National Coordinator for Health Information Technology (ONC). The KBs and the ONC list were applied to a prescription data set to simulate their use in clinical decision support. Results: The KBs contained 1.6 million (FDB), 4.5 million (Micromedex), and 4.8 million (Multum) clinical drug pairs. Altogether, there were 8.6 million unique pairs, of which 79% were found only in 1 KB and 5% in all 3 KBs. However, there was generally more agreement than disagreement in the severity rankings, especially in the contraindicated category. The KBs covered 99.8-99.9% of the alerts of the ONC list and would have generated 25 (FDB), 145 (Micromedex), and 84 (Multum) alerts per 1000 prescriptions. Conclusion: The commercial KBs differ considerably in size and quantity of alerts generated. There is less variability in severity ranking of DDIs than suggested by previous studies. All KBs provide very good coverage of the ONC list. More work is needed to standardize the editorial policies and evidence for inclusion of DDIs to reduce variation among knowledge sources and improve relevance. Some DDIs considered contraindicated in all 3 KBs might be possible candidates to add to the ONC list.
引用
收藏
页码:806 / 812
页数:7
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