Table 1.

Differences in medication-related clinical decision support between two systems

Alert Type	Legacy System	Commercial System
Allergy	Provides information on last override reason, if available	–
	Documentation as only an ‘allergy’	Documentation allows for differentiation between types (e.g., allergy, intolerance)
	Coded and free-text options for reaction	Drop-down list for 38 reactions, including ‘Other (see comments)’
	–	Provides information on the severity of the allergy (input during initial allergy documentation; based on documented reaction)
Drug-drug interactions	Tiering: Level 1 – unable to bypass (i.e., hard stop) Level 2 – interruptive and required override reason Level 3 – informational (i.e., not displayed to provider)	Tiering based on First Databank (e.g., very high, high)
		Color differentiation used for tiers of alerts
	Tailored based on multidisciplinary, expert opinion/published evidence/quality improvement efforts	–
	Two alerts included that were not in the commercial system	–
	–	‘Contraindicated’ medications able to bypassed
Geriatric	Presented to all healthcare providers	Majority presented as warning to only ordering provider
		‘Contraindicated’ alerts only presented to all providers
	Provided alternative medications and recommended doses	Provided alternative medications but no recommended dosing
Renal	Provided alternative medications and recommended doses (including degree of renal impairment)	Provided alternative medications but no recommended dosing