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J Am Med Inform Assoc 21:522-528 doi:10.1136/amiajnl-2013-001873
  • Brief communication

Integrating pharmacogenetic information and clinical decision support into the electronic health record

Editor's Choice
  1. Jon W McKeeby3
  1. 1Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
  2. 2Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
  3. 3Department of Clinical Research Informatics, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
  4. 4Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
  5. 5Genetic Disease Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
  6. 6Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
  7. 7Clinical Pharmacology Program, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
  1. Correspondence to Dr Barry R Goldspiel, NIH Clinical Center, Pharmacy Department, Bldg 10, Room 1C240, MSC 1196, Bethesda, MD 20892, USA; bgoldspiel{at}nih.gov
  • Received 1 April 2013
  • Revised 23 September 2013
  • Accepted 15 November 2013
  • Published Online First 3 December 2013

Abstract

Pharmacogenetics (PG) examines gene variations for drug disposition, response, or toxicity. At the National Institutes of Health Clinical Center (NIH CC), a multidepartment Pharmacogenetics Testing Implementation Committee (PGTIC) was established to develop clinical decision support (CDS) algorithms for abacavir, carbamazepine, and allopurinol, medications for which human leukocyte antigen (HLA) variants predict severe hypersensitivity reactions. Providing PG CDS in the electronic health record (EHR) during order entry could prevent adverse drug events. Medical Logic Module (MLM) programming was used to implement PG CDS in our EHR. The MLM checks to see if an HLA sequence-based gene test is ordered. A message regarding test status (result present, absent, pending, or test not ordered) is displayed on the order form, and the MLM determines if the prescriber can place the order, place it but require an over-ride reason, or be blocked from placing the order. Since implementation, more than 725 medication orders have been placed for over 230 patients by 154 different prescribers for the three drugs included in our PG program. Prescribers commonly used an over-ride reason when placing the order mainly because patients had been receiving the drug without reaction before implementation of the CDS program. Successful incorporation of PG CDS into the NIH CC EHR required a coordinated, interdisciplinary effort to ensure smooth activation and a positive effect on patient care. Prescribers have adapted to using the CDS and have ordered PG testing as a direct result of the implementation.

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