Pharmacogenomic Clinical Decision Support: A Review, How‐to Guide, and Future Vision

Abstract

Clinical decision support (CDS) is an essential part of any pharmacogenomics (PGx) implementation. Increasingly, institutions have implemented CDS tools in the clinical setting to bring PGx data into patient care, and several have published their experiences with these implementations. However, barriers remain that limit the ability of some programs to create CDS tools to fit their PGx needs. Therefore, the purpose of this review is to summarize the types, functions, and limitations of PGx CDS currently in practice. Then, we provide an approachable step-by-step how-to guide with a case example to help implementers bring PGx to the front lines of care regardless of their setting. Particular focus is paid to the five "rights" of CDS as a core around designing PGx CDS tools. Finally, we conclude with a discussion of opportunities and areas of growth for PGx CDS.

Pharmacogenomic alerts: Developing guidance for use by healthcare professionals

“…This study, which was based on an evidence review and wide multidisciplinary consultation, is consistent with and supports and adds to the findings of a recently published US review and guidance for pharmacogenomics clinical decision support by Wake et al 19 …”

“… This study highlights and outlines the development of system‐wide guidance in the United Kingdom for the sharing of pharmacogenomic information with prescribers, health professionals and patients. This study, which was based on an evidence review and wide multidisciplinary consultation, is consistent with and supports and adds to the findings of a recently published US review and guidance for pharmacogenomics clinical decision support by Wake et al 19 This study provides a foundation for further work including the future development and piloting of a national pharmacogenomics information record standard to support interoperability of pharmacogenomics information systems. …”

“…Our work is consistent with and adds to the findings of a recent US review and guidance for pharmacogenomics clinical decision support outlining the “five rights of CDS” that successful implementation of pharmacogenomics into clinical practice depends upon. 19 This requires “the right information” (providing actionable recommendations aligned to evidenced‐based guidelines); “the right person” (including alerting pharmacogenomic information only to healthcare professionals and patients who want and need to see it, respectively, and in a “patient‐friendly‐language”), “the right interventional format” (e.g., active versus passive alerts “that are not overly time‐consuming for a busy clinician”), “the right channel” (for access to pharmacogenomic information, e.g. an EHR, webpage or portal, or “stand‐alone clinical systems”), and interventions at “the right time” (in the workflow).…”

How to implement a pharmacogenetics service at your institution

“…and notify the prescriber that results are not available but are recommended to have before prescribing a drug (eg, TPMT-thiopurines) Detailed tutorials on creating internal CDS or utilizing an external platform for CDS exist. 42,49,50 CDS alerts can be interruptive and active (eg, pop-up alerts that require action) or passive alerts that appear in the background (eg, informational, require no action, Figure 3). Some institutions, including Duke University, rely on pharmacist's consultation notes placed manually in the EHR.…”

“…If provided at the appropriate time, CDS alerts prescribers that pharmacogenetic test results are available and provides guidance on their use. Alerts may also appear as “pretest” and notify the prescriber that results are not available but are recommended to have before prescribing a drug (eg, TPMT ‐thiopurines) Detailed tutorials on creating internal CDS or utilizing an external platform for CDS exist 42,49,50 . CDS alerts can be interruptive and active (eg, pop‐up alerts that require action) or passive alerts that appear in the background (eg, informational, require no action, Figure 3).…”