Healthc Inform Res.  2016 Jan;22(1):39-45. 10.4258/hir.2016.22.1.39.

New Alert Override Codes for the Drug Utilization Review System Derived from Outpatient Prescription Data from a Tertiary Teaching Hospital in Korea

• Jang C
• Yoo KB
• Kim W
• Park MY
• Ahn EK
• Park RW

• KMID: 2166915
• DOI: http://doi.org/10.4258/hir.2016.22.1.39

Abstract

OBJECTIVES
This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution.
METHODS
Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons.
RESULTS
We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for "prescription relating to operation" and "emergency situations." Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: "patient was not taking/will not take the medications involved in the DDI." Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes.
CONCLUSIONS
These new codes will facilitate the use of the drug-drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.

Keyword

Drug Utilization Review; Drug Interactions; Outpatient Care; Clinical Decision Support Systems; Contraindications

MeSH Terms

Ambulatory Care
Decision Support Systems, Clinical
Drug Interactions
Drug Utilization Review*
Drug Utilization*
Hospitals, Teaching*
Humans
Insurance, Health
Korea*
Outpatients*
Prescriptions*

Figure

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  Figure 1 Data selection process.

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