Screenshot: CDSS for automatic switching of drugs. Drugs prescribed to the patient before admission are listed on the left and the correspondingly switched drugs are shown on the right. The figure shows five examples of drug switches originating from the single steps of the algorithm (step 1–5). In example 2 an additional warning is displayed informing about differing indications of the switched drugs, in example 3 a combination drug is switched to two single agents. In example 4, the switch to a therapeutic equivalent required dosage adjustment (20mg simvastatin qd → 40mg pravastatin qd), and in example 5, no alternative could be suggested.