J Am Med Inform Assoc 19:735-743 doi:10.1136/amiajnl-2011-000612
  • Research and applications

High-priority drug–drug interactions for use in electronic health records

  1. David W Bates1,2,3
  1. 1Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Partners HealthCare System, Wellesley, Massachusetts, USA
  4. 4RAND Corporation, Santa Monica, California, USA
  5. 5Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  1. Correspondence to Dr Shobha Phansalkar, Clinical Informatics Research and Development (CIRD), Partners Healthcare System, Inc., 2nd Floor, 93 Worcester Street, PO Box 81905, Wellesley, MA 02481, USA; sphansalkar{at}
  • Received 27 September 2011
  • Accepted 29 March 2012
  • Published Online First 26 April 2012


Objective To develop a set of high-severity, clinically significant drug–drug interactions (DDIs) for use in electronic health records (EHRs).

Methods A panel of experts was convened with the goal of identifying critical DDIs that should be used for generating medication-related decision support alerts in all EHRs. Panelists included medication knowledge base vendors, EHR vendors, in-house knowledge base developers from academic medical centers, and both federal and private agencies involved in the regulation of medication use. Candidate DDIs were assessed by the panel based on the consequence of the interaction, severity levels assigned to them across various medication knowledge bases, availability of therapeutic alternatives, monitoring/management options, predisposing factors, and the probability of the interaction based on the strength of evidence available in the literature.

Results Of 31 DDIs considered to be high risk, the panel approved a final list of 15 interactions. Panelists agreed that this list represented drugs that are contraindicated for concurrent use, though it does not necessarily represent a complete list of all such interacting drug pairs. For other drug interactions, severity may depend on additional factors, such as patient conditions or timing of co-administration.

Discussion The panel provided recommendations on the creation, maintenance, and implementation of a central repository of high severity interactions.

Conclusions A set of highly clinically significant drug-drug interactions was identified, for which warnings should be generated in all EHRs. The panel highlighted the complexity of issues surrounding development and implementation of such a list.


  • Funding This study was funded by the U.S. Office of the National Coordinator (ONC) for Health Information Technology, through contract HHSP23320095649WC, task order HHSP23337009T. RAND has granted to the government, and others acting on its behalf, a paid-up, non-exclusive, irrevocable, worldwide license for all data produced in this contract, to reproduce, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, by or on behalf of the government.

  • Competing interests None.

  • Provenance and peer review Commissioned through a task order by the ONC (HHSP 23337009T); externally peer reviewed.

Related Article

Free Sample

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of JAMIA.
View free sample issue >>

Access policy for JAMIA

All content published in JAMIA is deposited with PubMed Central by the publisher with a 12 month embargo. Authors/funders may pay an Open Access fee of $2,000 to make the article free on the JAMIA website and PMC immediately on publication.

All content older than 12 months is freely available on this website.

AMIA members can log in with their JAMIA user name (email address) and password or via the AMIA website.

Navigate This Article