A02 Drugs for acid related disorders
A03 Drugs for functional gastrointestinal disorders A04 Antiemetics and antinauseants
A05 Bile and liver therapy
A06 Laxatives
A07 Antidiarrheals, intestinal antiinflammatory/antiinfective agents A08 Antiobesity preparations, excluding diet products
A10 Drugs used in diabetes
A11 Vitamins
A16 Other alimentary tract and metabolism products B01 Antithrombotic agents
B02 Antihemorrhagics B03 Antianemic preparations
B05 Plasma substitutes and perfusion solutions B06 Other hematological agents
C01 Cardiac therapy C02 Antihypertensives
C03 Diuretics
C04 Peripheral vasodilators C07 Beta blocking agents C08 Calcium channel blockers
C09 Agents acting on the renin-angiotensin system C10 Lipid modifying agents
D01 Antifungals for dermatological use
D03 Preparations for treatment of wounds & ulcers D05 Antipsoriatics
D06 Antibiotics and chemotherapeutics for dermatological use D10 Anti-acne preparations
Three-digits of ATC code Code name
H01 Pituitary and hypothalamic hormones H02 Corticosteroids for systemic use H05 Calcium homeostasis
J01 Antibacterials for systemic use J02 Antimycotics for systemic use J04 Antimycobacterials
J05 Antivirals for systemic use
J06 Immune sera and immunoglobulins
J07 Vaccines
L01 Cytostatics
L02 Endocrine therapy
L03 Immunomodulating agents L04 Immunosuppressive agents
M01 Antiinflammatory and antirheumatic products M03 Muscle relaxants
M04 Antigout preparations
M05 Drugs for treatment of bone diseases
M09 Other drugs for disorders of the musculo-skeletal system
N01 Anesthetics
N02 Analgesics
N03 Antiepileptics N04 Anti-parkinson drugs
N05 Psycholeptics
N06 Psychoanaleptics
N07 Other nervous system drugs
P01 Antiprotozoals
R01 Nasal preparations R03 Anti-asthmatics
R05 Cough and cold preparations R06 Antihistamines for systemic use R07 Other respiratory system products
Three-digits of ATC code Code name V04 Diagnostic agents
V08 Contrast media
V09 Diagnostic radiopharmaceuticals V10 Therapeutic radiopharmaceuticals
Appendix 5. Medication list of DDI alerts by admitting department
Emergency Department
Medication 1 Medication 2 Count
Anti-inflammatory and antirheumatic products
Anti-inflammatory and antirheumatic
products 14025
Cardiac therapy Drugs for obstructive airway diseases 420 Antithrombotic agents Anti-inflammatory and antirheumatic
products 308
Mineral supplements Diuretics 159
Anti-inflammatory and antirheumatic
products Analgesics 119
Diuretics Antibacterials for systemic use 82
Peripheral vasodilators Anti-inflammatory and antirheumatic
products 49
Antibacterials for systemic use Antiepileptics 27
Blood substitutes and perfusion solutions Diuretics 26
Antineoplastic agents Anti-inflammatory and antirheumatic
products 17
Lipid modifying agents Antibacterials for systemic use 12
Antihemorrhagics Antihemorrhagics 10
Antineoplastic agents Analgesics 4
Analgesics Analgesics 4
Anti-acne preparations Antibacterials for systemic use 2
Cardiac therapy Anesthetics 1
Antimycotics for systemic use Lipid modifying agents 1
Antineoplastic agents Antithrombotic agents 1
Anesthetics Psycholeptics 1
Anti-parkinson drugs Analgesics 1
General Ward
Medication 1 Medication 2 Count
Anti-inflammatory and antirheumatic products
Anti-inflammatory and antirheumatic
products 8401
Mineral supplements Diuretics 1950
Antithrombotic agents Anti-inflammatory and antirheumatic
products 1563
Diuretics Antibacterials for systemic use 1299
Antibacterials for systemic use Antiepileptics 1191
Cardiac therapy Drugs for obstructive airway diseases 726
Antimycotics for systemic use Psycholeptics 722
Calcium channel blockers Antimycobacterials 582
Diuretics Immunosuppressants 393
Antihemorrhagics Antihemorrhagics 391
Antineoplastic agents Anti-inflammatory and antirheumatic
products 242
Blood substitutes and perfusion solutions Diuretics 215
Vitamins Vitamins 198
Peripheral vasodilators Anti-inflammatory and antirheumatic
products 178
Anti-inflammatory and antirheumatic
products Analgesics 173
Lipid modifying agents Antimycotics for systemic use 152 Lipid modifying agents Antibacterials for systemic use 126
Antithrombotic agents Antineoplastic agents 62
Cardiac therapy Psychoanaleptics 58
Cardiac therapy Psycholeptics 50
Analgesics Anti-parkinson drugs 31
Antibacterials for systemic use Muscle relaxants 28
Antiepileptics Ophthalmologicals 27
Blood substitutes and perfusion solutions Cardiac therapy 8 Antibacterials for systemic use Antibacterials for systemic use 6
Anti-parkinson drugs Psychoanaleptics 6
Cardiac therapy Antibacterials for systemic use 4
Psycholeptics Antivirals for systemic use 2
Other gynecologicals Analgesics 1
Anesthetics Psycholeptics 1
Intensive Care Unit
Medication 1 Medication 2 Count
Cardiac therapy Drugs for obstructive airway diseases 1377
Antibacterials for systemic use Antiepileptics 480
Mineral supplements Diuretics 401
Diuretics Antibacterials for systemic use 243
Antithrombotic agents Anti-inflammatory and antirheumatic
products 83
Anti-inflammatory and antirheumatic products
Anti-inflammatory and antirheumatic
products 78
Antihemorrhagics Antihemorrhagics 55
Lipid modifying agents Antimycotics for systemic use 51
Blood substitutes and perfusion solutions Diuretics 47
Antivirals for systemic use Psycholeptics 43
Blood substitutes and perfusion solutions Cardiac therapy 30
Calcium channel blockers Antimycobacterials 30
Antimycotics for systemic use Psycholeptics 29
Peripheral vasodilators Anti-inflammatory and antirheumatic
products 26
Psycholeptics Antivirals for systemic use 24
Cardiac therapy Psycholeptics 17
Diuretics Immunosuppressants 16
Anti-inflammatory and antirheumatic
products Analgesics 13
Immunosuppressants Immunosuppressants 5
Lipid modifying agents Antibacterials for systemic use 4
Antimycotics for systemic use Antimycobacterials 3
Ophthalmologicals Antiepileptics 1
- ABSTRACT -
Evaluation of drug-drug interaction in the EHR data Eun Kyoung Ahn
Department of Biomedical Informatics The Graduate School of Medicine, Ajou University
(Supervised by Professor Rae Woong Park)
Drug–drug interactions (DDIs) caused by co-prescriptions can alter the effectiveness of treatment or occurrence of adverse drug events (ADEs). Also, it in itself could be life-threatening to patients. An electronic alert for DDI is one of the most successful components of electronic medical record (EMR) systems for reducing the DDI-associated ADEs by providing alerts and/or detailed information at the moment of prescribing.
The primary objectives of this study is to determine whether the incidence of
alerts for DDI and their override rates differed by admitting department
(emergency department, ED; general ward, GW; intensive care unit, ICU). We also tried to reveal the
difference in drug pairs causing DDI alerts and reasons for alert overrides among the
three departments by analyzing a longitudinal electronic health record (EHR) data and
The risk of DDI among admitting departments were compared and analyzed the cause of prescribing which is possible to occur DDI with the purpose of providing baseline knowledge for acceptable clinical decision support system (CDSS). This is a retrospective cohort study using a tertiary hospital in Korea. The participants of this study are all patient who were visited/admitted into ED, GW or ICU, from September 1, 2009 to March 31, 2013, incidentally. The risk for DDI alert and alert overrides were compared among admitting department (ED, GW and ICU). Also, the cause of prescribing possible DDI drugs was analyzed by manual review of all free-text record recorded by physicians.
The incidence of DDI alert is 6.4% (0.13 person-year) in total, order by 18.4% in ICU, 6.3% in ED and 6.2% in GW, respectively. After adjusted in age, gender, age-adjusted Charlson’s comorbidity index (CCI), administration of chemotherapeutic drug, mean number of drug per day, and transfer from other department, the risk of DDI alerts in ED (HR, 1.923;
95% CI, 1.823-2.028) and in ICU (HR, 1.845; 95% CI, 1.635-2.083) are higher than in GW (p-value<0.001). The alert overrides in ED is higher than in GW (HR, 13.007; 95% CI, 10.800-15.664), but in ICU is lower than in GW (HR, 0.805; 95% CI, 0.647-1.001) (p-value<0.001) after adjusting the confounders. In ED and GW, co-prescriptions within ‘anti-inflammatory and antirheumatic products’ are most frequent (90.6% in ED, 43.8% in GW), on the other hand, co-prescriptions of ‘cardiac therapy’ drug and drug for obstructive airway disease are the most frequent in ICU, by categorized using three digits of ATC code. As the results of analysis on the cause of alert overrides from free-text record, ‘clinically irrelevant alerts’ is
to reduce DDI alerts and alert overrides. Improving alerting rule for discharge medication may reduce 2/3 of total inappropriate alerts in ED. Sophisticated DDI rule-updates considering the patient’s clinical information may be required for GW to make the alerting system acceptable to prescribers.
Keyword: Drug-drug interaction, Clinical decision support system, Electronic medical record, Admitting department, Pharmaco-epidemiology, Alert fatigue, Alert overrides