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Unique evaluation

by Prof. Dr. Lars L. Gustafsson

A few days ago Swedish Medical Products Agency (MPA) published a unique comparison of two drug-drug interaction databases called EES (Drug-Drug interactions in the Electronic Expert Support provided by The Information Service Board for Swedish Pharmacies) and SFINX http://www.lakemedelsverket.se/Alla-nyheter/NYHETER-2011/Utvardering-av-interaktionsmodulerna-SFINX-och-EES-/)

The Drug-Drug Interaction Function in EES is originally developed by the US Company First Databank and intended to be used as an Electronic Decision Support for pharmacists when dispensing drugs at pharmacies. SFINX is developed primarily for use as a decision support system for physicians and nurses in drug prescribing by clinical pharmacologists and pharmacists at Karolinska Institutet in Stockholm, at the Finnish Company Medbase and by experts at Stockholm Healthcare Region (1-3).

The responsible officer for the evaluation is Anders Carlsten in collaboration with internal and external experts at Swedish Medical Products Agency. The Swedish Ministry of Health has ordered this comparative study (http://www.regeringen.se/content/1/c6/16/50/49/374dd647.pdf ). This is initiated by discussions in Sweden about risks to have two different knowledge databases for drug-drug interactions but also a firm commitment by the Minister of Health to provide a number of EES functions not only at pharmacies but also at Swedish healthcare institutions (www.lakemedelsvarlden.se/zino.aspx?articleID=13916). It is quite amazing that this comparison between EES interaction function and SFINX was initiated by a Ministry led by a politician, Göran Hägglund, and not by the National Board of Health and Welfare (www.socialstyrelsen.se) in charge of providing Swedish Healthcare Institutions with guidelines on best practices.

The evaluation is in Swedish but of great interest for everyone interested in how healthcare staff should be supported with scientifically based advice at point of care in future. The evaluation recommends SFINX to be used preferably as decision support in pharmacies and in healthcare institutions . The advantage is that SFINX has drug-drug interaction alerts based on each substance in comparison with the EES drug-drug interaction function that mostly has shared drug-drug interaction alerts for a class of drugs. In addition, EES drug-drug interaction function lacks information for about 22% of available drug substances in Sweden. Dr Anders Carlsten also comment that it is not optimal if two different knowledge databases with different classification systems (3 for EES drug-drug interaction function and 4 for SFINX) are used simultaneously in the country.

A thrilling time is in front of us. The intention from the Minister has been to provide the whole contents of EES, including the drug-drug interaction function, to all Swedish physicians (www.lakemedelsvarlden.se/zino.aspx?articleID=13916) but this evaluation recommends SFINX to be used at all pharmacies in Sweden. How will the decision be taken on what drug-drug interaction database should be used be used electronically at point of care and at pharmacies when dispensing drugs in Sweden? Is the minister to take the decision or is it the National Board of Health and Welfare making the decision based on recommendations from their scientific experts? I do hope that the evaluation of MPA is published in English. This evaluation shows that the question on what knowledge databases should be used in healthcare is hot. In my mind, it is self-evident that we only need knowledge databases that are based on scientific findings and developed in an open matter and freely available in the public domain. The risks to use different drug-drug interaction information in pharmacies and in healthcare institutions in the same country is not known but is likely not negligible.


  1. Tillgängliggörande av EES för vårdgivare. Rapport: Utvärdering och införande av ESS. 2011-03-17. Apotekens Service AB.

  2. Böttiger Y, Laine K, Andersson ML, Korhonen T, Molin B, Ovesjö ML, Tirkkonen T, Rane A, Gustafsson LL, Eiermann B. SFINX-a drug-drug interaction database designed for clinical decision support systems. Eur J Clin Pharmacol 2009;65:627-33 ( http://www.ncbi.nlm.nih.gov/pubmed/19205683).

  3. Eiermann B, Bastholm-Rahmner P, Korkmaz S, Lilja B, Veg A, Wettermark B, Gustafsson LL. Knowledge databases for clinical decision support in drug prescribing- development, quality assurance, management, integration, implementation and evaluation of clinical value. Decision Support Systems, Book edited by: Chiang S. Jao, ISBN 978-953-7619-64-00, January 2010, INTECH,