Electronic Health Record Design and Implementation for Pharmacogenomics: a Local Perspective

Details

• Alternative Title:
  Genet Med
• Personal Author:
  Peterson, Josh F. ; Bowton, Erica ; Field, Julie R. ; Beller, Marc ; Mitchell, Jennifer ; Schildcrout, Jonathan ; Gregg, William ; Johnson, Kevin ; Jirjis, Jim N ; Roden, Dan M. ; Pulley, Jill M. ; Denny, Josh C.
• Description:
  Purpose
  
  The design of electronic health records (EHR) to translate genomic medicine into clinical care is crucial to successful introduction of new genomic services, yet there are few published guides to implementation.
  
  Methods
  
  The design, implemented features, and evolution of a locally developed EHR that supports a large pharmacogenomics program at a tertiary care academic medical center was tracked over a 4-year development period.
  
  Results
  
  Developers and program staff created EHR mechanisms for ordering a pharmacogenomics panel in advance of clinical need (preemptive genotyping) and in response to a specific drug indication. Genetic data from panel-based genotyping were sequestered from the EHR until drug-gene interactions (DGIs) met evidentiary standards and deemed clinically actionable. A service to translate genotype to predicted drug response phenotype populated a summary of DGIs, triggered inpatient and outpatient clinical decision support, updated laboratory records, and created gene results within online personal health records.
  
  Conclusion
  
  The design of a locally developed EHR supporting pharmacogenomics has generalizable utility. The challenge of representing genomic data in a comprehensible and clinically actionable format is discussed along with reflection on the scalability of the model to larger sets of genomic data.
  
  
• Subjects:
  Academic Medical Centers Decision Support Systems, Clinical Electronic Health Records Genotype Health Plan Implementation Humans Pharmacogenetics Phenotype Translational Research, Biomedical
• Source:
  Genet Med. 15(10):833-841
• Pubmed ID:
  24009000
• Pubmed Central ID:
  PMC3925979
• Document Type:
  Journal Article
• Funding:
  U01 HL105198/HL/NHLBI NIH HHSUnited States/ ; U47CI000824/CI/NCPDCID CDC HHSUnited States/ ; U19 HL065962/HL/NHLBI NIH HHSUnited States/ ; U01HL105198/HL/NHLBI NIH HHSUnited States/ ; U47 CI000824/CI/NCPDCID CDC HHSUnited States/ ; U19HL065962/HL/NHLBI NIH HHSUnited States/ ; U01 HG006378/HG/NHGRI NIH HHSUnited States/ ; UL1 RR024975/RR/NCRR NIH HHSUnited States/ ; U01HG006378/HG/NHGRI NIH HHSUnited States/
• Volume:
  15
• Issue:
  10
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f05e954d42f12f2177c60b06f4e4e83374145e50d162b17825e56efe6dc678eb
• Download URL:
  https://stacks.cdc.gov/view/cdc/29849/cdc_29849_DS1.pdf
• File Type:
  [PDF - 571.46 KB ]