Abstract
As the adoption of information technology in healthcare is rising, the potentiality of moving Pharmacogenomics from benchside to bedside is aggravated. This paper reviews the current status of Pharmacogenomics (PGx) information and the attempts for incorporating them into the Electronic Health Record (EHR) system through Decision Support Systems (DSSs). Rigorous review strategies of PGx information and providing context-relevant recommendations in form of action plan- dose adjustment, lab tests rather than just information- would be ideal for making clinical recommendations out of PGx information. Lastly, realistic projections of what pharmacogenomics can provide is another important aspect in incorporating Pharmacogenomics into health information technology.
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Wilkinson, G. R., Drug metabolism and variability among patients in drug response. N. Engl. J. Med. 352(21):2211–2221, 2005.
Roden, D. M., and George, A. L., Jr., The genetic basis of variability in drug responses. Nat. Rev. Drug Discov. 1(1):37–44, 2002.
Exner, D. V., Dries, D. L., Domanski, M. J., and Cohn, J. N., Lesser response to angiotensin-converting–enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N. Engl. J. Med. 344(18):1351–1357, 2001.
Taylor, A. L., Ziesche, S., Yancy, C., Carson, P., D’Agostino, R., Jr., Ferdinand, K., Worcel, M., et al., Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N. Engl. J. Med. 351(20):2049–2057, 2004.
Ma, Q., and Lu, A. Y. H., Pharmacogenetics, pharmacogenomics, and individualized medicine. Pharmacol. Rev. 63(2):437–459, 2011.
Watson, J. D., and Crick, F. H., Molecular structure of nucleic acids: A structure for deoxyribose nucleic acid. Nature 171(4356):737–738, 1953. doi:10.1038/171737a0.
Meyer, U. A., Timeline: Pharmacogenetics – five decades of therapeutic lessons from genetic diversity. Nat. Rev. Genet. 5(9):669–676, 2004. doi:10.1038/nrg1428.
Ma, J. D., Lee, K. C., and Kuo, G. M., Clinical application of pharmacogenomics. J. Pharm. Pract. 25(4):417–427, 2012.
Shi, M. M., Bleavins, M. R., and Felix, A., Pharmacogenetic application in drug development and clinical trials. Drug Metab. Dispos. 29(4):591–595, 2001.
Roper, N., Storer, B., Bona, R., and Fang, M., Validation and comparison of pharmacogenetics-based warfarin dosing algorithms for application of pharmacogenetic testing. J. Mol. Diagn. 12(3):283–291, 2010.
Wang, M., Lang, X., Cui, S., Fei, K., Zou, L., Cao, J., Wang, Y., et al., Clinical application of pharmacogenetic-based warfarin-dosing algorithm in patients of Han nationality after rheumatic valve replacement: A randomized and controlled trial. Int. J. Med. Sci. 9(6):472, 2012.
Feldman, E. A., The Genetic Information Nondiscrimination Act (GINA): Public policy and medical practice in the age of personalized medicine. J. Gen. Intern. Med. 27(6):743–746, 2012.
Whirl-Carrillo, M., McDonagh, E. M., Hebert, J. M., Gong, L., Sangkuhl, K., Thorn, C. F., Klein, T. E., et al., Pharmacogenomics knowledge for personalized medicine. Clin. Pharmacol. Ther. 92(4):414, 2012.
Hernandez-Boussard, T., Whirl-Carrillo, M., Hebert, J. M., Gong, L., Owen, R., Gong, M., … and Woon, M., The pharmacogenetics and pharmacogenomics knowledge base: accentuating the knowledge. Nucleic Acids Res. 36(suppl 1)D913–D918, 2008.
O’Donnell, P. H., Bush, A., Spitz, J., Danahey, K., Saner, D., Das, S., Ratain, M. J., et al., The 1200 patients project: Creating a new medical model system for clinical implementation of pharmacogenomics. Clin. Pharmacol. Ther. 92(4):446–449, 2012.
Johnson, J. A., Cavallari, L. H., Beitelshees, A. L., Lewis, J. P., Shuldiner, A. R., and Roden, D. M., Pharmacogenomics: Application to the management of cardiovascular disease. Clin. Pharmacol. Ther. 90(4):519–531, 2011.
Gottesman, O., Kuivaniemi, H., Tromp, G., Faucett, W. A., Li, R., Manolio, T. A., Brilliant, M., et al., The electronic medical records and genomics (eMERGE) network: Past, present, and future. Gen. Med. 15(10):761–771, 2013.
Schildcrout, J. S., Denny, J. C., Bowton, E., Gregg, W., Pulley, J. M., Basford, M. A., Ritchie, M. D., et al., Optimizing drug outcomes through pharmacogenetics: A case for preemptive genotyping. Clin. Pharmacol. Ther. 92(2):235–242, 2012.
Pulley, J. M., Denny, J. C., Peterson, J. F., Bernard, G. R., Vnencak‐Jones, C. L., Ramirez, A. H., Crawford, D. C., et al., Operational implementation of prospective genotyping for personalized medicine: The design of the Vanderbilt PREDICT project. Clin. Pharmacol. Ther. 92(1):87–95, 2012.
Goldspiel, B. R., Flegel, W. A., DiPatrizio, G., Sissung, T., Adams, S. D., Penzak, S. R., Figg, W. D., et al., Integrating pharmacogenetic information and clinical decision support into the electronic health record. J. Am. Med. Inform. Assoc. 21(3):522–528, 2014.
Overby, C., Tarczy-Hornoch, P., Hoath, J. I., Kalet, I. J., and Veenstra, D. L., Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support. BMC Bioinf. 11(Suppl 9), 2010. doi:10.1186/1471-2105-11-s9-s10
Shabo, A., Meaningful use of pharmacogenomics in health records: Semantics should be made explicit. Pharmacogenomics 11(1):81–87, 2010.
Shabo, A., Streamlining genetic testing by standardizing its report formats and exchange among all stakeholders. EPMA J. 5(Suppl 1), 2014. doi:10.1186/1878-5085-5-s1-a61
Peterson, J. F., Bowton, E., Field, J. R., Beller, M., Mitchell, J., Schildcrout, J., Pulley, J. M., et al., Electronic health record design and implementation for pharmacogenomics: A local perspective. Genet. Med. 15(10):833–841, 2013.
Shirts, B. H., Salama, J. S., Aronson, S. J., Chung, W. K., Gray, S. W., Hindorff, L. A., Van Allen, E. M., et.al., CSER and eMERGE: current and potential state of the display of genetic information in the electronic health record. J. Am. Med. Inform. Assoc. ocv065.
Bell, G. C., Crews, K. R., Wilkinson, M. R., Haidar, C. E., Hicks, J. K., Baker, D. K., … Hoffman, J. M., Development and use of active clinical decision support for preemptive pharmacogenomics. J. Am. Med. Inform. Assoc. 21(E1), 2014. doi:10.1136/amiajnl-2013-001993
Sauver, J. L., Bielinski, S. J., Olson, J. E., Bell, E. J., Gree, M. E., Jacobson, D. J., and Vitek, C. R., Integrating pharmacogenomics into clinical practice: Promise vs reality. Am. J. Med. 129(10):193–199, 2016.
Masys, D. R., Jarvik, G. P., Abernethy, N. F., Anderson, N. R., Papanicolaou, G. J., Paltoo, D. N., Levy, H. P., et al., Technical desiderata for the integration of genomic data into electronic health records. J. Biomed. Inform. 45(3):419–422, 2012.
Devine, E. B., Lee, C. J., Overby, C. L., Abernethy, N., McCune, J., Smith, J. W., and Tarczy-Hornoch, P., 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. 83(7):473–483, 2014.
Peterson, J. F., Field, J. R., Shi, Y., Schildcrout, J. S., Denny, J. C., Mcgregor, T. L., Clayton, E. W., et al., Attitudes of clinicians following large-scale pharmacogenomics implementation. Pharm. J. 16(4):393–398, 2015.
Ury, A. G., Storing and interpreting genomic information in widely deployed electronic health record systems. Genet. Med. 15(10):779–785, 2013.
Squassina, A., Manchia, M., Manolopoulos, V. G., Artac, M., Lappa-Manakou, C., Karkabouna, S., Patrinos, G. P., et al., Realities and expectations of pharmacogenomics and personalized medicine: Impact of translating genetic knowledge into clinical practice. Pharmacogenomics 11(8):1149–1167, 2010.
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Alanazi, A. Incorporating Pharmacogenomics into Health Information Technology, Electronic Health Record and Decision Support System: An Overview. J Med Syst 41, 19 (2017). https://doi.org/10.1007/s10916-016-0673-4
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DOI: https://doi.org/10.1007/s10916-016-0673-4