Development and use of active clinical decision support for preemptive pharmacogenomics

Prescribing medication is changing and with the help of CDS and EHR there will be more and more "gene-based drug prescribing".

Background

Many institutions have CDS as part of their EHR however few institutions have patients genetically tested and use this information to prescribe medication. This institution is looking at patients who have been genetically tested and have and CDS within the EHR and alerts that are generated based on the medication prescribed and wether or not the medication is a high risk medication for this patient. If a medication is a high risk medication it alerts the physician prompting the physician to potentially prescribe a medication that would be most beneficial for the patient or even change the dose that would be most beneficial for the patient based on genetics.

Methods

Using the St. Judes PG4KDS protocol, samples were collected and approximately 225 results were placed in the EHR. This is important because it is now important to determine if there are recommendations for the gene-drug pair. These recommendations are from the CPIC guidelines. Once determined they are then placed into the EHR system as such pairs, the CDS is then activated when a physician orders a medication that could potentially be high risk based on the pharmocogentic test results. This warning can serve different purposes, it can suggest a different medication type all together or perhaps a change in dose medication, where as previously medication was dosed based on weight.

Results

During an 18month period of information collection and new alerts implemented it was ultimately found that the alerts were not being ignored and the correct medication and dosage was being prescribed. It was found that approximately "95% patients who had a post-test alert at the time of the first prescription received the appropriate change in therapy as guided by the on-screen alert."