Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration

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PROJECT SUMMARY/ABSTRACT Drug-drug interactions (DDIs) are preventable adverse events that are responsible for 5–14% of adverse drug reactions (ADRs) in hospitalized patients and frequently occur in up to 13% of elderly ambulatory patients. Exposure to life-threatening DDIs continues to occur despite the widespread availability of clinical decision support systems (CDS). Due to Meaningful Use requirements, most electronic health record (EHR) vendors have implemented DDI CDS functionality using the underlying logic provided by drug knowledge-base vendors. A persistent issue is that DDI alerts are overridden at rates as high as 90%. While patients can play a critical role in preventing potentially catastrophic harm due to DDIs, here are very few tools that help them engage in shared decision making about DDI risks. Recently, studies of interactive decision dashboards have shown the potential to foster informed decision making by patients. These decision aids allow patients and clinicians to deliberate together about the advantages and disadvantages of different therapies and arrive at decisions that are concordant with both clinicians' knowledge and patients' preferences. Accordingly, the overarching goal of this study is to advance the DDI CDS frontier beyond physician-centered decision making to patient-centered shared decision making. Our central hypothesis is that interoperable shared decision tools will enhance patient-provider decision making regarding the risks and benefits of interacting medications. The proposed project will use emerging CDS standards (CQL, CDS Hooks, and SMART on FHIR) and a learning health community (CDS Connect) to enable: (i) novel shared decision-making dashboards that graphically communicate risks and decision options related to potential DDIs and (ii) broad interoperability for highly actionable DDI CDS artifacts. Patients and providers will be able to jointly determine the most appropriate actions to mitigate potential harm. We will accomplish our objectives by pursuing the following specific aims: Aim 1: Design and evaluate a user-centered CDS dashboard for shared decision making of drug prescribing concerning risk of DDI harm; Aim 2: Enable contextual DDI CDS rules using CDS Connect; and Aim 3) Conduct a pilot dissemination of the DDI authoring process, the knowledge artifacts, interoperability, and the shared decision-making dashboard. This project will markedly improve CDS for DDIs by simplifying the authoring process and demonstrating interoperable shared patient-physician DDI decision making. We expect patients will value this critical information as part of their care plan and that providers will benefit from risk information that is provided real-time without relying on memory recall. Our novel approach, involving partners across multiple organizations and environments including experts in drug interactions, biomedical informatics, healthcare information technology standards, and shared-decision making will result in safer healthcare with respect to the use of medications.