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Editor's Correspondence
July 27, 2009

Overrides of Medication Alerts in Ambulatory Care

Arch Intern Med. 2009;169(14):1336-1340. doi:10.1001/archinternmed.2009.224

Isaac et al,1 writing in the February 9, 2009, issue of the Archives, describe an important and disturbing situation in which the promise of electronic prescribing systems to protect patient safety has been only partially realized. We have encountered a similar situation, which encompasses both electronic and paper prescriptions, in a system that generates clinical alerts using pharmacy claims data for prescriptions that have recently been filled. We agree with the authors' point (and the article by Shah et al2 that they cite) that such systems can achieve better physician acceptance if they limit alerts to those with the highest clinical importance, thereby avoiding the initiation of “alert fatigue.” We have also found that adding other sources of information—medical and laboratory claims, test results, feedback from physicians, and self-reported data from patients who are enrolled in disease management or complete health risk assessments—appears to greatly increase the specificity and credibility of clinical alerts, and the number of clinicians who respond by discontinuing the use of potentially dangerous medications.3,4

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