Barriers to Adoption of Tailored Drug–Drug Interaction Clinical Decision Support

Abstract

Objective Despite the benefits of the tailored drug–drug interaction (DDI) alerts and the broad dissemination strategy, the uptake of our tailored DDI alert algorithms that are enhanced with patient-specific and context-specific factors has been limited. The goal of the study was to examine barriers and health care system dynamics related to implementing tailored DDI alerts and identify the factors that would drive optimization and improvement of DDI alerts. Methods We employed a qualitative research approach, conducting interviews with a participant interview guide framed based on Proctor's taxonomy of implementation outcomes and informed by the Theoretical Domains Framework. Participants included pharmacists with informatics roles within hospitals, chief medical informatics officers, and associate medical informatics directors/officers. Our data analysis was informed by the technique used in grounded theory analysis, and the reporting of open coding results was based on a modified version of the Safety-Related Electronic Health Record Research Reporting Framework. Results Our analysis generated 15 barriers, and we mapped the interconnections of these barriers, which clustered around three entities (i.e., users, organizations, and technical stakeholders). Our findings revealed that misaligned interests regarding DDI alert performance and misaligned expectations regarding DDI alert optimizations among these entities within health care organizations could result in system inertia in implementing tailored DDI alerts. Conclusion Health care organizations primarily determine the implementation and optimization of DDI alerts, and it is essential to identify and demonstrate value metrics that health care organizations prioritize to enable tailored DDI alert implementation. This could be achieved via a multifaceted approach, such as partnering with health care organizations that have the capacity to adopt tailored DDI alerts and identifying specialists who know users' needs, liaise with organizations and vendors, and facilitate technical stakeholders' work. In the future, researchers can adopt the systematic approach to study tailored DDI implementation problems from other system perspectives (e.g., the vendors' system).

Pharmacoinformatics-enabled Interventions Improved Care Coordination and Identified Pharmacy-Related Safety Issues in a Multicultural Medicare Population

“…Unlike traditional communications between the pharmacists and prescriber that are transaction-based and single-drug-focused at the point of dispensing, the pharmacist-led surveillance system coordinates communication with the member, and their nurse care manager and provider/prescriber into a process of care that is ongoing and person-centered. 30 Further, contrary to most pharmacist–prescriber interactions, the MCI program pharmacist has access to relevant health care data with expanded interoperability into warehouses (e.g., electronic health records (EHR), medical and pharmacy claims) to derive a complete picture of the member's health (e.g., medical history, all medications being taken, diagnostic findings to target correct therapies, etc.) at the point of care and can surmount Health Insurance Portability and Accountability Act (HIPAA)-related barriers, as the member's health care benefits are covered by the payor.…”

“…at the point of care and can surmount Health Insurance Portability and Accountability Act (HIPAA)-related barriers, as the member's health care benefits are covered by the payor. 30 Management of chronic conditions in these high-risk Medicare members requires coordination of information to bring resolution. In addition to clinical data, pharmacists collect information from the member to identify and deliver education needs, and assess barriers and behaviors, while acting as a trust broker of their care.…”

Interprofessional Evaluation of a Medication Clinical Decision Support System Prior to Implementation

“…25 Other investigations emphasize the involvement of key players as hybrid experts, who understand the clinical workflow as well as the technical backgrounds (e.g., clinical pharmacists). 54 55 If technical requirements are considered from the outset, this may lead to more effective and rapid transformation and implementation of improvements into clinical practice. We integrated both recommendations as well as the integration of IT support for a more effective and rapid realization in our evaluation approach.…”