An Electronic Health Record Approach to Understanding Drug to Drug Interactions and Associated Knowledge Gaps in Intergrated Care of Multimorbidity.

Multimorbid patients are prescribed a number of medications in parallel, which may often interact with each other, resulting in adverse effects. However, clinical guidelines on prescription of medications predominantly focus on individual conditions do not consider the guidance in the context of other guidelines, resulting in conflicts. C3-Cloud is an integrated care architecture managing multimorbidity, which amongst others, provides clinical decision support, based on reconciled guidelines, and active monitoring of drug interactions. To identify the severe interactions that resulted from multimorbidity management, in order to reevaluate guidelines as well as to identify knowledge gaps in prescribing practice. Method: Descriptive statistical analysis of interactions identified by the C3-Cloud clinical decision support, collected from the C3-Cloud FHIR repository. As part of a feasibility study, a number of interactions were identified, along with variable practice in how chemicals are represented in the EHR. 191 known severe interactions were identified. The Atorvastatin/Verapamil interaction was the most frequent. The approach has identified a number of interactions where the severity was not available, highlighting the need for further clinical review.