Harnessing Health Information Technology to Prevent Medication-Induced Birth Defects

The Institute of Medicine has identified the prevention of birth defects as one of six priorities for the Nation's health. Between 1 and 3 percent of all U.S. births (150,000 infants annually) are born with some form of physical or mental birth defect, some of which are due to the use of high-risk medications. It is estimated that each year, 12 million U.S. women use medications that increase the risk of birth defects.  With concurrent use of contraception, birth defects associated with these medications can be vastly reduced. Unfortunately, when prescribing these medications clinicians counsel women about contraception less than 20 percent of the time. An estimated 12 million women a year use medications known to increase the risk of birth defects, subsequently exposing approximately 6 percent of those pregnancies. 

Dr. Schwarz and her team developed and evaluated a clinical decision support (CDS) system that alerted clinicians when they prescribed high-risk medications and prompted them to counsel women about the risks and need for adequate contraception. The team conducted a series of focus groups with clinicians and patients seen in academic and community-based practices to learn what information about risk of medication-induced birth defects would be most useful. Data from these discussions informed the design of a CDS that was integrated with an electronic health record.          

The specific aims of the study were to:

• Develop and implement two CDS systems designed to alert ambulatory clinicians to the risk of medication-induced birth defects.
• Evaluate the effect of two CDS systems designed to alert ambulatory clinicians to the risk of medication-induced birth defects.        

Evaluation of the CDS compared two types of CDS alerts. One was a multi-faceted alert that provided tailored information with links to assist safe prescribing; the other was streamlined and provided cautionary alert only. The study indicated that multi-faceted and streamlined CDS alerts were both associated with slight increases in family planning services; however there was no difference in the relative improvement between the two arms. The multi-faceted CDS group reported a greater increase in the number of times they counseled women about the risks of medication use during pregnancy. The streamlined CDS group reported greater clinician satisfaction with CDS usability.