Development and evaluation of advanced clinical decision support systems: a pharmacoepidemiological approach

The Institute of Medicine report ‘To Err is Human’ brought awareness about medication errors and drug related problems which led to initiatives such as clinical decision support systems (CDSS) to improve patient safety. CDSS are computer systems that assist clinicians in decision making about individual patients at the point in time that these decisions are made by for example providing alerts at the moment of prescribing. These systems have the potential to prevent medication errors such as drug-drug interactions (DDIs), dosing errors, and contraindicated administrations.
Most currently implemented CDSS are still relatively simple meaning that they do not take into account the individual context of a patient, which results in non-specific alerts and a phenomenon called alert fatigue. Physicians become desensitized to the excessive number of safety alerts they receive, leading to cancelling or overriding all alerts. A context-specific CDSS alerting system displays only the relevant alerts which makes the CDSS more useful and an added value for health care professionals. This project’s first focus is the development of such context-specific risk prediction rules for DDIs leading to heart rhythm disorders. The second objective is the development of a context-specific CDSS for drug allergy screening. The third focus is on the exploration of the use of multicentric databases for translational and epidemiological research into unwanted effects and other drug related problems.