Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2017

Open Access 01-12-2017 | Research article

Integrating clinical decision support systems for pharmacogenomic testing into clinical routine - a scoping review of designs of user-system interactions in recent system development

Authors: Marc Hinderer, Martin Boeker, Sebastian A. Wagner, Martin Lablans, Stephanie Newe, Jan L. Hülsemann, Michael Neumaier, Harald Binder, Harald Renz, Till Acker, Hans-Ulrich Prokosch, Martin Sedlmayr

Published in: BMC Medical Informatics and Decision Making | Issue 1/2017

Login to get access

Abstract

Background

Pharmacogenomic clinical decision support systems (CDSS) have the potential to help overcome some of the barriers for translating pharmacogenomic knowledge into clinical routine. Before developing a prototype it is crucial for developers to know which pharmacogenomic CDSS features and user-system interactions have yet been developed, implemented and tested in previous pharmacogenomic CDSS efforts and if they have been successfully applied. We address this issue by providing an overview of the designs of user-system interactions of recently developed pharmacogenomic CDSS.

Methods

We searched PubMed for pharmacogenomic CDSS published between January 1, 2012 and November 15, 2016. Thirty-two out of 118 identified articles were summarized and included in the final analysis. We then compared the designs of user-system interactions of the 20 pharmacogenomic CDSS we had identified.

Results

Alerts are the most widespread tools for physician-system interactions, but need to be implemented carefully to prevent alert fatigue and avoid liabilities. Pharmacogenomic test results and override reasons stored in the local EHR might help communicate pharmacogenomic information to other internal care providers. Integrating patients into user-system interactions through patient letters and online portals might be crucial for transferring pharmacogenomic data to external health care providers. Inbox messages inform physicians about new pharmacogenomic test results and enable them to request pharmacogenomic consultations. Search engines enable physicians to compare medical treatment options based on a patient’s genotype.

Conclusions

Within the last 5 years, several pharmacogenomic CDSS have been developed. However, most of the included articles are solely describing prototypes of pharmacogenomic CDSS rather than evaluating them. To support the development of prototypes further evaluation efforts will be necessary. In the future, pharmacogenomic CDSS will likely include prediction models to identify patients who are suitable for preemptive genotyping.
Appendix
Available only for authorised users
Literature
1.
Stanek EJ, Sanders CL, Taber KA, et al. Adoption of Pharmacogenomic Testing by US Physicians: Results of a Nationwide Survey. Clin Pharmacol Ther. 2012;91(3):450–8.CrossRefPubMed
2.
3.
The Royal Society. Personalised medicines: hopes and realities. R Soc. 2005;52.
4.
Caudle KE, Klein TE, Hoffman JM, et al. Incorporation of pharmacogenomics into routine clinical practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline development process. Curr Drug Metab. 2014;15(2):209–17.CrossRefPubMedPubMedCentral
5.
Swen JJ, Nijenhuis M, de Boer A, et al. Pharmacogenetics: From Bench to Byte-An Update of Guidelines. Clin Pharmacol Ther. 2011;89(5):662–73.CrossRefPubMed
6.
Johansen Taber KA, Dickinson BD. Pharmacogenomic knowledge gaps and educational resource needs among physicians in selected specialties. Pharmacogenomics Pers Med. 2014;7:145–62.CrossRef
7.
Shuldiner AR, Relling MV, Peterson JF, et al. The Pharmacogenomics Research Network Translational Pharmacogenetics Program: Overcoming Challenges of Real-World Implementation. Clin Pharmacol Ther. 2013;94(2):207–10.CrossRefPubMedPubMedCentral
8.
Gottesman O, Scott SA, Ellis SB, et al. The CLIPMERGE PGx Program: Clinical Implementation of Personalized Medicine Through Electronic Health Records and Genomics-Pharmacogenomics. Clin Pharmacol Ther. 2013;94(2):214–7.CrossRefPubMedPubMedCentral
9.
Goldspiel BR, Flegel WA, DiPatrizio G, et al. Integrating pharmacogenetic information and clinical decision support into the electronic health record. J Am Med Inform Assoc. 2014;21(3):522–8.CrossRefPubMed
10.
Blagec K, Romagnoli KM, Boyce RD, Samwald M. Examining perceptions of the usefulness and usability of a mobile-based system for pharmacogenomics clinical decision support: a mixed methods study. Peer J. 2016;4:e1671.CrossRefPubMedPubMedCentral
11.
Overby CL, Devine EB, Abernethy N, McCune JS, Devine EB, Lee CJ, Overby CL, Abernethy N, McCune J, Smith JW, Tarczy-Hornoch P. Making Pharmacogenomic-based Prescribing Alerts More Effective: A Scenario-based Pilot Study with Physicians. J Biomed Inform. 2015;55(4):249–59.CrossRefPubMedPubMedCentral
12.
Bell GC, Crews KR, Wilkinson MR, et al. Development and use of active clinical decision support for preemptive pharmacogenomics. J Am Med Inf Assoc. 2014;21(e1):e93–9.CrossRef
13.
Welch BM, Kawamoto K. Clinical decision support for genetically guided personalized medicine: a systematic review. J Am Med Inf Assoc. 2013;20(2):388–400.CrossRef
14.
Dunnenberger HM, Crews KR, Hoffman JM, et al. Preemptive Clinical Pharmacogenetics Implementation: Current programs in five United States medical centers. Annu Rev Pharmacol Toxicol. 2015;55:89–106.CrossRefPubMed
15.
Hicks JK, Dunnenberger HM, Gumpper KF, Haidar CE, Hoffman JM. Integrating pharmacogenomics into electronic health records with clinical decision support. Am J Heal Pharm. 2016;73(23):1967–76.CrossRef
16.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefPubMedPubMedCentral
17.
18.
Minarro-Gimenez JA, Blagec K, Boyce RD, Adlassnig K-P, Samwald M. An Ontology-Based, Mobile-Optimized System for Pharmacogenomic Decision Support at the Point-of-Care. PLoS ONE. 2014;9(5):e93769.CrossRefPubMedPubMedCentral
19.
Pulley JM, Denny JC, Peterson JF, et al. Operational implementation of prospective genotyping for personalized medicine: The design of the Vanderbilt PREDICT project. Clin Pharmacol Ther. 2012;92(1):87–95.CrossRefPubMedPubMedCentral
20.
Peterson JF, Bowton E, Field JR, et al. Electronic Health Record Design and Implementation for Pharmacogenomics: a Local Perspective. Genet Med. 2013;15(10):833–41.CrossRefPubMedPubMedCentral
21.
Altar CA, Carhart JM, Allen JD, Hall-Flavin DK, Dechairo BM, Winner JG. Clinical validity: Combinatorial pharmacogenomics predicts antidepressant responses and healthcare utilizations better than single gene phenotypes. Pharmacogenomics J. 2015;15(5):443–51.CrossRefPubMed
22.
O’Donnell PH, Danahey K, Jacobs M, et al. Adoption of a clinical pharmacogenomics implementation program during outpatient care-initial results of the University of Chicago “1,200 Patients Project”. Am J Med Genet Part C Semin Med Genet. 2014;166C(1):68–75.CrossRefPubMed
23.
Hussain S, Kenigsberg BB, Danahey K, et al. Disease–Drug Database for Pharmacogenomic-Based Prescribing. Clin Pharmacol Ther. 2016;100(2):179–90.CrossRefPubMed
24.
Melton BL, Zillich AJ, Saleem JJ, Russ AL, Tisdale JE, Overholser BR. Iterative Development and Evaluation of a Pharmacogenomic-Guided Clinical Decision Support System for Warfarin Dosing. Appl Clin Inform. 2016;7(4):1088–106.CrossRefPubMed
25.
Ji Y, Skierka JM, Blommel JH, et al. Preemptive Pharmacogenomic Testing for Precision Medicine: A Comprehensive Analysis of Five Actionable Pharmacogenomic Genes Using Next-Generation DNA Sequencing and a Customized CYP2D6 Genotyping Cascade. J Mol Diagnostics. 2016;18(3):438–45.CrossRef
26.
Cabrera M, Finkelstein J. A Use Case to Support Precision Medicine for Frequently Hospitalized Older Adults with Polypharmacy. AMIA Jt Summits Transl Sci Proc. 2012;16–21.
27.
Finkelstein J, Friedman C, Hripcsak G, Cabrera M. Potential utility of precision medicine for older adults with polypharmacy: a case series study. Pharmacogenomics Pers Med. 2016;9:31–45.CrossRef
28.
Manzi SF, Fusaro VA, Chadwick L, et al. Creating a scalable clinical pharmacogenomics service with automated interpretation and medical record result integration – experience from a pediatric tertiary care facility. J Am Med Informatics Assoc. 2017;1(24):74–80.CrossRef
29.
Caraballo PJ, Hodge LS, Bielinski SJ, et al. Multidisciplinary model to implement pharmacogenomics at the point of care. Genet Med. American College of Medical Genetics and Genomics; 2016
30.
Hicks JK, Stowe D, Willner MA, et al. Implementation of Clinical Pharmacogenomics within a Large Health System: From Electronic Health Record Decision Support to Consultation Services. Pharmacotherapy. 2016;36(8):940–8.CrossRefPubMed
31.
Gammal RS, Crews KR, Haidar CE, et al. Pharmacogenetics for Safe Codeine Use in Sickle Cell Disease. Pediatrics. 2016;138(1):e20153479.CrossRefPubMed
32.
Nishimura AA, Shirts BH, Dorschner MO, et al. Development of clinical decision support alerts for pharmacogenomic incidental findings from exome sequencing. Genet Med. 2015;17(11):939–42.CrossRefPubMedPubMedCentral
33.
Nishimura AA, Shirts BH, Salama J, Smith JW, Devine B, Tarczy-Hornoch P. Physician perspectives of CYP2C19 and clopidogrel drug-gene interaction active clinical decision support alerts. Int J Med Inform. 2016;86:117–25.CrossRefPubMed
34.
Fusaro VA, Brownstein C, Wolf W, et al. Development of a Scalable Pharmacogenomic Clinical Decision Support Service. AMIA Jt Summits Transl Sci Proc. 2013;2013(October 2016):60.PubMed
35.
Rohrer Vitek CR, Nicholson WT, Schultz C, Caraballo PJ. Evaluation of the use of clinical decision support and online resources for pharmacogenomics education. Pharmacogenomics. 2015;16(14):1595–603.CrossRefPubMed
36.
Owusu-Obeng A, Weitzel KW, Hatton RC, et al. Emerging Roles for Pharmacists in Clinical Implementation of Pharmacogenomics. Pharmacotherapy. 2014;34(10):1102–12.CrossRefPubMedPubMedCentral
37.
Overby CL, Tarczy-Hornoch P, Kalet IJ, et al. Developing a Prototype System for Integrating Pharmacogenomics Findings into Clinical Practice. J Pers Med Med. 2012;2(4):241–56.CrossRef
38.
Devine EB, Lee C-J, Overby CL, et al. Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: A mixed methods approach. Int J Med Inform. 2014;83(7):473–83.CrossRefPubMedPubMedCentral
39.
Hoffman JM, Haidar CE, Wilkinson MR, et al. PG4KDS: A Model for the Clinical Implementation of Pre-emptive Pharmacogenetics. Am J Med Genet Part C Semin Med Genet. 2014;166(1):45–55.CrossRef
40.
Lærum H, Bremer S, Bergan S, Grünfeld T. A taste of individualized medicine: physicians’ reactions to automated genetic interpretations. J Am Med Inform Assoc. 2014;21(e1):e143–6.CrossRefPubMed
41.
Brixner D, Biltaji E, Bress A, et al. The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy. J Med Econ. 2016;19(3):213–28.CrossRefPubMed
42.
Sweet K, Gordon ES, Sturm AC, et al. Design and Implementation of a Randomized Controlled Trial of Genomic Counseling for Patients with Chronic Disease. J Pers Med. 2014;4:1–19.CrossRefPubMedPubMedCentral
43.
Dawes M, Aloise MN, Ang JS, et al. Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study. CMAJ Open. 2016;4(3):E528–34.CrossRefPubMedPubMedCentral
44.
Overby CL, Devine EB, Abernethy N, McCune JS, Tarczy-Hornoch P. Making Pharmacogenomic-based Prescribing Alerts More Effective: A Scenario-based Pilot Study with Physicians. J Biomed Inform. 2015;55(4):249–59.CrossRefPubMedPubMedCentral
45.
46.
Happe A, Pouliquen B, Burgun A, Cuggia M, Le Beux P. Combining voice recognition and automatic indexing of medical reports. Stud Heal Technol Inform. 2002;90:382–7.
47.
48.
Huettig M, Buscher G, Menzel T, Scheppach W, Puppe F, Buscher HP. A Diagnostic Expert System for Structured Reports, Quality Assessment, and Training of Residents in Sonography. Med Klin. 2004;99(3):117–22.CrossRef
49.
Karim S, Fegeler C, Boeckler D, Schwartz LH, Kauczor H-U, von Tengg-Kobligk H. Development, implementation, and evaluation of a structured reporting web tool for abdominal aortic aneurysms. JMIR Res Protoc. 2013;2(2):e30. http://​doi.​org/​10.​2196/​resprot.​2417.
50.
Schildcrout JS, Shi Y, Danciu I, et al. A prognostic model based on readily available clinical data enriched a pre-emptive pharmacogenetic testing program. J Clin Epidemiol. 2016;72:107–15.CrossRefPubMed
51.
Oemrawsingh RM, Akkerhuis KM, Van Vark LC, et al. Individualized Angiotensin-Converting Enzyme (ACE)-Inhibitor Therapy in Stable Coronary Artery Disease Based on Clinical and Pharmacogenetic Determinants: The PERindopril GENEtic (PERGENE) Risk Model. J Am Heart Assoc. 2016;5(3):e002688.CrossRefPubMedPubMedCentral
52.
Teng K, DiPiero J, Meese T, et al. Institutional Profile: Cleveland Clinic’s Center for Personalized Healthcare: setting the stage for value-based care. Pharmacogenomics. 2014;15(5):587–91.CrossRefPubMed
Metadata
Title
Integrating clinical decision support systems for pharmacogenomic testing into clinical routine - a scoping review of designs of user-system interactions in recent system development
Authors
Marc Hinderer
Martin Boeker
Sebastian A. Wagner
Martin Lablans
Stephanie Newe
Jan L. Hülsemann
Michael Neumaier
Harald Binder
Harald Renz
Till Acker
Hans-Ulrich Prokosch
Martin Sedlmayr
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2017
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-017-0480-y

Other articles of this Issue 1/2017

BMC Medical Informatics and Decision Making 1/2017 Go to the issue

Software

A Fast Healthcare Interoperability Resources (FHIR) layer implemented over i2b2

Research article

Using a linked database for epidemiology across the primary and secondary care divide: acute kidney injury

Research article

Assessing the usability by clinicians of VISION: A hierarchical display of patient-collected physiological information to clinicians

Research article

Renal transplant patient acceptance of a self-management support system

Research article

Multiple constraints compromise decision-making about implantable medical devices for individual patients: qualitative interviews with physicians

Research article

Validation of an algorithm that determines stroke diagnostic code accuracy in a Japanese hospital-based cancer registry using electronic medical records