Opportunities to implement a sustainable genomic medicine program: lessons learned from the IGNITE Network

Levy, Kenneth D.; Blake, Kathryn; Fletcher-Hoppe, Colette; Franciosi, James P.; Goto, Daisuke; Hicks, J. Kevin; Holmes, Ann M.; Kanuri, Sri Harsha; Madden, Ebony; Musty, Michael; Orlando, Lori A.; Pratt, Victoria M.; Ramos, Michelle; Wu, R. Ryanne; Ginsburg, Geoffrey S.

doi:10.1038/s41436-018-0080-y

Cited by 43 publications

(39 citation statements)

References 12 publications

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“…Ongoing efforts are needed to sustain the pharmacogenomic clinical services that have been implemented and to demonstrate value. Continuous provider education, maintenance and further development of CDS tools, and genomic test reimbursement are key considerations for sustainability . Although reimbursement of pharmacogenomic tests may minimize the financial burden for institutions and patients, it often fails to provide significant revenue.…”

Section: Clinical Pharmacogenomics Implementation Sciencementioning

confidence: 99%

“…Continuous provider education, maintenance and further development of CDS tools, and genomic test reimbursement are key considerations for sustainability. 61 Although reimbursement of pharmacogenomic tests may minimize the financial burden for institutions and patients, it often fails to provide significant revenue. In an era of DTC genomic tests and lowered costs of whole exome sequencing, reimbursement models for cognitive services related to reinterpreting data and applying these data to patient care may emerge as key drivers for sustainability.…”

Section: Maintaining Sustainability and Demonstrating Valuementioning

confidence: 99%

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Precision pharmacotherapy: Integrating pharmacogenomics into clinical pharmacy practice

Hicks

Aquilante

Dunnenberger

et al. 2019

J Am Coll Clin Pharm

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Precision pharmacotherapy encompasses the use of therapeutic drug monitoring, evaluation of liver and renal function, genomics, and environmental and lifestyle exposures; and analysis of other unique patient or disease characteristics to guide drug selection and dosing. This paper articulates real‐world clinical applications of precision pharmacotherapy, focusing exclusively on the emerging field of clinical pharmacogenomics. Precision pharmacotherapy is evolving rapidly, and clinical pharmacists now play an invaluable role in the clinical implementation, education, and research applications of pharmacogenomics. This paper provides an overview of the evolution of pharmacogenomics in clinical pharmacy practice, together with recommendations on how the American College of Clinical Pharmacy (ACCP) can support the advancement of clinical pharmacogenomics implementation, education, and research. Commonalities among successful clinical pharmacogenomic implementation and education programs are identified, with recommendations for how ACCP can leverage and advance these common themes. Opportunities are also provided to support the research needed to move the practice and application of pharmacogenomics forward.

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Section: Clinical Pharmacogenomics Implementation Sciencementioning

confidence: 99%

Section: Maintaining Sustainability and Demonstrating Valuementioning

confidence: 99%

Precision pharmacotherapy: Integrating pharmacogenomics into clinical pharmacy practice

Hicks

Aquilante

Dunnenberger

et al. 2019

J Am Coll Clin Pharm

View full text Add to dashboard Cite

show abstract

“…68 The NHGRI Implementing GeNomics In pracTicE (IGNITE) Network framework identifies best practices and lessons learned to achieve sustainable adoption of genomic technologies in health care systems. [69][70][71] Key components of best-practice implementation within health systems are the structured use of genomic information in clinical care that is linked to (and ideally) supported within the EHR to be guided by CDS. CDS ''provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare.''…”

Section: Workforce Developmentmentioning

confidence: 99%

Educational and Ethical Considerations for Genetic Test Implementation Within Health Care Systems

Kurnat-Thoma

2020

Network and Systems Medicine

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Introduction: The precision medicine (PM) era presents unprecedented proliferation of genetic/genomic initiatives, information, and bioinformatic tools to enhance targeted molecular diagnosis and therapeutic treatments. As of February 29, 2020, the National Institutes of Health (NIH) National Center for Biotechnology Information (NCBI) Genetic Testing Registry contained 64,860 genetic tests for 12,268 conditions and 18,686 genes from 560 laboratories, and the Food and Drug Administration had 404 entries for pharmacogeneomic biomarkers used in drug labeling. Population-based research initiatives including NIH's All of Us and Veterans Affairs' Million Veteran Program, and the UK Biobank, combine use of genomic biorepositories with electronic medical records (i.e., National Human Genome Research Institute's [NHGRI's] electronic Medical Records and Genomics [eMERGE] Network). Learning health care systems are implementing clinical genomics screening programs and precision oncology programs. However, there are insufficient medical geneticists, nurse geneticists, and genetics counselors to implement expanding number of clinical genetic tests that are required for PM implementation. Methods: A scoping review of current (2014-2019) trends in U.S. genomic medicine translation, PM health care provider workforce education and training resources, and genomic clinical decision support (CDS) implementation tools was conducted. Results: Health care delivery institutions and systems are beginning to implement genetic tests that are driving PM, particularly in the areas of oncology, pharmacogenetics, obstetrics, and prenatal diagnostics. To ensure safe adoption and clinical translation of PM, health care systems have an ethical responsibility to ensure their providers and front-line staff are adequately prepared to order, use, and interpret genetic test information. Conclusion: There are a number of high-quality evidenced-based educational resources and CDS tools available. Strong partnerships between health care system leaders, front-line providers and staff coupled with reasonable goal setting can help drive PM translation interests.

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“…The US National Human Genome Research Institute's (NHGRI) Implementing GeNomics In pracTicE (IGNITE) Network [123] funds six major university medical institutions and 14 community partners to implement genomic medicine. The member institutions identify several key factors ensuring sustainability: health care worker education, development of clinical genetic decision tools for medications which may have multiple drug-drug-gene interactions and be prescribed by a wide range of specialties, high quality cost effectiveness studies to justify use and reimbursement, impacts on health care workers' workflows rated as beneficial, and reimbursement for genetic testing [124][125][126].…”

Section: Progress In Implementing Pharmacogenetic Guidelines In Largementioning

confidence: 99%

Optimising Seniors’ Metabolism of Medications and Avoiding Adverse Drug Events Using Data on How Metabolism by Their P450 Enzymes Varies with Ancestry and Drug–Drug and Drug–Drug–Gene Interactions

Thomas

2020

JPM

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Many individuals ≥65 have multiple illnesses and polypharmacy. Primary care physicians prescribe >70% of their medications and renew specialists’ prescriptions. Seventy-five percent of all medications are metabolised by P450 cytochrome enzymes. This article provides unique detailed tables how to avoid adverse drug events and optimise prescribing based on two key databases. DrugBank is a detailed database of 13,000 medications and both the P450 and other complex pathways that metabolise them. The Flockhart Tables are detailed lists of the P450 enzymes and also include all the medications which inhibit or induce metabolism by P450 cytochrome enzymes, which can result in undertreatment, overtreatment, or potentially toxic levels. Humans have used medications for a few decades and these enzymes have not been subject to evolutionary pressure. Thus, there is enormous variation in enzymatic functioning and by ancestry. Differences for ancestry groups in genetic metabolism based on a worldwide meta-analysis are discussed and this article provides advice how to prescribe for individuals of different ancestry. Prescribing advice from two key organisations, the Dutch Pharmacogenetics Working Group and the Clinical Pharmacogenetics Implementation Consortium is summarised. Currently, detailed pharmacogenomic advice is only available in some specialist clinics in major hospitals. However, this article provides detailed pharmacogenomic advice for primary care and other physicians and also physicians working in rural and remote areas worldwide. Physicians could quickly search the tables for the medications they intend to prescribe.

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Opportunities to implement a sustainable genomic medicine program: lessons learned from the IGNITE Network

Cited by 43 publications

References 12 publications

Precision pharmacotherapy: Integrating pharmacogenomics into clinical pharmacy practice

Precision pharmacotherapy: Integrating pharmacogenomics into clinical pharmacy practice

Educational and Ethical Considerations for Genetic Test Implementation Within Health Care Systems

Optimising Seniors’ Metabolism of Medications and Avoiding Adverse Drug Events Using Data on How Metabolism by Their P450 Enzymes Varies with Ancestry and Drug–Drug and Drug–Drug–Gene Interactions

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