Electronic health record design and implementation for pharmacogenomics: a local perspective

Purpose:The design of electronic health records to translate genomic medicine into clinical care is crucial to successful introduction of new genomic services, yet there are few published guides to implementation.Methods:The design, implemented features, and evolution of a locally developed electronic health record that supports a large pharmacogenomics program at a tertiary-care academic medical center was tracked over a 4-year development period.Results:Developers and program staff created electronic health record mechanisms for ordering a pharmacogenomics panel in advance of clinical need (preemptive genotyping) and in response to a specific drug indication. Genetic data from panel-based genotyping were sequestered from the electronic health record until drug–gene interactions met evidentiary standards and deemed clinically actionable. A service to translate genotype to predicted drug-response phenotype populated a summary of drug–gene interactions, triggered inpatient and outpatient clinical decision support, updated laboratory records, and created gene results within online personal health records.Conclusion:The design of a locally developed electronic health record supporting pharmacogenomics has generalizable utility. The challenge of representing genomic data in a comprehensible and clinically actionable format is discussed along with reflection on the scalability of the model to larger sets of genomic data.Genet Med 15 10, 833–841.Genetics in Medicine (2013); 15 10, 833–841. doi:10.1038/gim.2013.109

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