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. 2020 Jan 1;27(1):154-158.
doi: 10.1093/jamia/ocz177.

Integrating pharmacogenomics into the electronic health record by implementing genomic indicators

Pedro J Caraballo  1   2 , Joseph A Sutton  3 , Jyothsna Giri  4 , Jessica A Wright  5 , Wayne T Nicholson  6 , Iftikhar J Kullo  7 , Mark A Parkulo  2   8 , Suzette J Bielinski  9 , Ann M Moyer  10
Affiliations

Integrating pharmacogenomics into the electronic health record by implementing genomic indicators

Pedro J Caraballo et al. J Am Med Inform Assoc. .

Abstract

Pharmacogenomics (PGx) clinical decision support integrated into the electronic health record (EHR) has the potential to provide relevant knowledge to clinicians to enable individualized care. However, past experience implementing PGx clinical decision support into multiple EHR platforms has identified important clinical, procedural, and technical challenges. Commercial EHRs have been widely criticized for the lack of readiness to implement precision medicine. Herein, we share our experiences and lessons learned implementing new EHR functionality charting PGx phenotypes in a unique repository, genomic indicators, instead of using the problem or allergy list. The Gen-Ind has additional features including a brief description of the clinical impact, a hyperlink to the original laboratory report, and links to additional educational resources. The automatic generation of genomic indicators from interfaced PGx test results facilitates implementation and long-term maintenance of PGx data in the EHR and can be used as criteria for synchronous and asynchronous CDS.

Keywords: clinical decision support systems; delivery of health care; electronic health record; medical informatics; medication therapy management; pharmacogenetics; precision medicine.

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Figures

Figure 1.
Figure 1.
Example of a pharmacogenomics genomic indicator.
Figure 2.
Figure 2.
Implementation of genomic indicators and related clinical decision support. The structure laboratory (lab) data are interfaced to the electronic health record (EHR) and can be viewed by the clinicians. The genomic translation engine uses the lab data and the pharmacogenomics (PGx) translation table to define and storage the genomic indicators which can be viewed by the clinicians. Maintenance tools are available to update the genomic indicators as needed. The clinical decision support (CDS) engine can access the lab data and the genomic indicators to send asynchronous and synchronous alerts to the clinicians. The monitors represent clinician access. HL7: health level 7.
See this image and copyright information in PMC

References

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