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Prescribing Complexity and the Need for Real-Time Decision Support
Medication errors remain a persistent challenge in clinical practice, particularly during the prescribing stage of the medication-use process. The World Health Organization has reported that more than 53% of medication errors occur at this stage, making it the most common point of failure within the medication pathway [1].
Prescribing errors include inappropriate drug selection, contraindicated drug combinations, incorrect dosing, and failure to account for patient-specific factors such as comorbid conditions or pregnancy. These errors contribute to adverse drug events (ADEs), defined as harmful or unintended effects resulting from medication use.
Evidence from Vietnam highlights the scale of the issue. A 2023 multicentre prospective study involving hypertensive outpatients across three hospitals reported that 90.23% of patients experienced at least one drug-related problem, with inappropriate prescribing identified as a major contributor [2].
In routine practice, clinicians frequently manage patients receiving multiple medicines within complex dosing regimens. Evaluating numerous potential drug interactions, contraindications, and patient-specific risk factors can be challenging within busy clinical workflows.
To help address these challenges, healthcare facilities are increasingly integrating clinical decision support systems (CDSS) to aid with prescribing decision support. MIMS Clinical Decision Solutions delivers evidence-based, real-time prescribing alerts directly within hospital information systems (HIS) and electronic medical records (EMR), supporting clinicians at the point of care. The following analysis summarises implementation data from two healthcare facilities in Vietnam that integrated MIMS Clinical Decision Solutions into routine prescribing workflows over a 12-month period.
Implementation data collected over a 12-month period from a public hospital and a private hospital in Vietnam demonstrate the scale and complexity of medication-related risks encountered in routine clinical practice. The findings presented below include both combined results across the two healthcare facilities and facility-specific observations where appropriate, reflecting differences in alert types and prescribing workflows.
Across both healthcare facilities, MIMS Clinical Decision Solutions identified prescribing considerations spanning contraindicated and severe drug interactions, drug–disease interactions, duplicate therapy, and prescribing precautions for pregnancy and breastfeeding. In the public hospital alone, the system identified more than 22,800 contraindicated drug interactions and over 60,600 severe drug interaction alerts, reflecting the complexity of prescribing in high-volume healthcare environments.
The findings also highlight the importance of supporting patient-specific prescribing decisions. More than 6,800 contraindicated drug–disease interactions and 94,500 “use with caution” alerts were identified in patients with complex comorbidities. Across both healthcare facilities, clinicians also received more than 54,000 pregnancy-related alerts, including 1,989 contraindicated medicines, alongside more than 13,900 breastfeeding alerts. In the private hospital, 174,948 duplicate therapy alerts and over 76,600 drug interaction alerts further illustrate how frequently medication safety considerations arise during everyday prescribing.
Rather than requiring clinicians to manually assess every potential interaction or contraindication, MIMS Clinical Decision Solutions delivers evidence-based alerts directly within existing HIS and EMR workflows at the point of prescribing. These real-world implementation findings demonstrate how integrated clinical decision support can help healthcare organisations strengthen medication safety processes, support more informed prescribing decisions, and enable clinicians to focus their attention on the risks that matter most.
Drug–drug interactions (DDIs) remain a major contributor to preventable prescribing errors. Certain interactions are classified as contraindicated, indicating that the combination should not be used due to a high risk of clinically significant harm.
During the study period, MIMS Clinical Decision Solutions identified 22,828 contraindicated interaction alerts in the public hospital and 334 alerts in the private hospital, based on guidance from the Ministry of Health Vietnam. The substantially higher volume observed in the public setting likely reflects greater prescribing complexity, broader formularies, and higher patient throughput.
Severe drug interactions were also frequently identified, with 60,654 alerts recorded in the public hospital and 14,345 in the private hospital. These findings highlight the volume of clinically significant prescribing risks that may arise within routine practice, particularly in settings managing large numbers of patients receiving multiple concurrent therapies.
By comparison, the private hospital recorded 62,287 alerts categorised as “other” interactions, typically representing mild to moderate interaction risks. While generally lower in severity, these interactions may still warrant monitoring, therapy modification, or dose adjustment depending on the clinical context.
By providing real-time visibility of these risks during prescribing, clinical decision support can support earlier review of potentially problematic medication combinations before treatment decisions are finalised.
Supporting Safer Prescribing in Patients with Complex Comorbidities
Drug–disease interactions occur when a medicine may worsen an existing condition or become unsuitable due to a patient’s underlying disease.
In the public hospital setting, MIMS Clinical Decision Solutions generated 6,860 contraindicated drug–disease alerts and 94,532 “use with caution” alerts. These alerts were commonly associated with patients presenting with complex comorbidities, including:
- Chronic kidney disease
- Hepatic impairment
- Diabetes mellitus
- Advanced malignancy
- Post-transplant immunosuppression
Management of these patients frequently involves multiple concurrent therapies and careful treatment individualisation. Real-time decision support can therefore assist clinicians by highlighting potential contraindications and precautionary prescribing considerations within routine workflows.
Supporting Medication Safety in Pregnancy and Breastfeeding
Medication use during pregnancy and breastfeeding requires careful consideration of potential risks to both mother and child.
Across both healthcare facilities, 54,255 pregnancy-related alerts were generated, including 1,989 categorised as contraindicated medicines. These alerts support clinicians in reviewing the benefit-risk profile of medicines when prescribing during pregnancy.
In the public hospital, 13,685 breastfeeding alerts were generated involving medicines that may be excreted in breast milk. Such alerts can assist in identifying therapies that may require substitution, monitoring, or further clinical evaluation depending on individual patient circumstances. These findings demonstrate the importance of readily accessible prescribing guidance when managing vulnerable patient populations.
Identification of Duplicate Therapy
Duplicate therapy refers to the concurrent prescribing of medicines with the same active ingredient or overlapping pharmacological effects without clear therapeutic justification.
In the private hospital, 174,948 duplicate therapy alerts were generated over the study period, highlighting how commonly this issue can occur in high-volume prescribing environments.
Although duplicate therapy may sometimes be perceived as lower risk than contraindicated interactions, it can contribute to:
- Excessive pharmacological exposure
- Increased risk of adverse drug reactions
- Medication reconciliation errors
The volume of alerts observed suggests that automated review of prescribing decisions may play an important role in supporting medication optimisation and reducing unnecessary duplication.
As prescribing complexity continues to increase, healthcare organisations are seeking tools that support both patient safety and clinician efficiency.
When integrated into HIS and EMR environments, MIMS Clinical Decision Solutions provides:
- Evidence-based drug information from internationally recognised sources
- Severity-stratified interaction alerts that help clinicians prioritise clinically significant risks
- Drug–drug, drug–disease, pregnancy, breastfeeding, and duplicate therapy screening within a single workflow
- API-based integration that enables alerts to appear directly during prescribing
By embedding evidence-based guidance into existing workflows, healthcare facilities can provide clinicians with relevant information at the point of decision-making while minimising workflow disruption.
Clinical and Operational Implications
Maintaining prescribing safety requires continuous evaluation of medication-related risks, particularly in settings characterised by:
- High prescribing volumes
- Use of multiple concurrent therapies
- Complex comorbidity profiles
Implementation data from Vietnamese healthcare facilities demonstrate that clinical decision support systems can identify a broad range of medication-related risks during routine practice, including contraindicated interactions, severe DDIs, drug–disease interactions, pregnancy- and breastfeeding-related risks, and duplicate therapy.
These findings highlight the role of integrated decision support in helping healthcare organisations strengthen medication safety processes, support clinicians in managing prescribing complexity, and promote more consistent medication review practices.
Conclusion
Medication prescribing errors remain a significant contributor to preventable adverse drug events. Real-world implementation data from healthcare facilities in Vietnam demonstrate the scale and variety of prescribing risks encountered in routine clinical practice.
By delivering evidence-based alerts directly within prescribing workflows, MIMS Clinical Decision Solutions supports clinicians in identifying potential medication-related risks at the point of care, including contraindicated interactions, drug–disease considerations, duplicate therapy, and prescribing considerations in pregnancy and breastfeeding.
As healthcare systems continue to pursue safer, more efficient prescribing practices, integrated clinical decision support is becoming an increasingly important component of modern medication management.
To learn how MIMS Clinical Decision Solutions can support medication safety initiatives within your organisation, contact the MIMS team to explore integration options and implementation strategies tailored to your healthcare environment.
References
- World Health Organization. Medication Without Harm: Policy Brief. 2023. See more
- Huynh BH, Nathisuwan S, Tragulpiankit P et al. Drug-Related Problems and Pharmacists’ Interventions in Hypertensive Outpatients: A Multicentre Prospective Study in Three Vietnamese Hospitals. J Pharm Technol. 2023;39(6):259–268. See more