This study of more than 50 ambulatory practices discovered that about 7 in 1000 outpatients receive a medication that counters black box warnings. While these events were associated with very few instances of patient harm, investigators noted that older patients with multiple medical problems and taking more medications appeared to be at greater risk for being prescribed these medications. Data collection occurred through review of electronic health records that offered limited clinical decision support or alerts to providers. The authors suggest that improvements in decision support may minimize the potential for such black box warning violations. This study reports an overall lower rate of prescribing violations compared to past published work.