title: Electronic health record design and implementation for pharmacogenomics: a local perspective.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1] Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; [2] Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
authors.forename: Josh F
authors.initials: JF
authors.lastname: Peterson
authors.forename: Erica
authors.initials: E
authors.lastname: Bowton
authors.forename: Julie R
authors.initials: JR
authors.lastname: Field
authors.forename: Marc
authors.initials: M
authors.lastname: Beller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mitchell
authors.forename: Jonathan
authors.initials: J
authors.lastname: Schildcrout
authors.forename: William
authors.initials: W
authors.lastname: Gregg
authors.forename: Kevin
authors.initials: K
authors.lastname: Johnson
authors.forename: Jim N
authors.initials: JN
authors.lastname: Jirjis
authors.forename: Dan M
authors.initials: DM
authors.lastname: Roden
authors.forename: Jill M
authors.initials: JM
authors.lastname: Pulley
authors.forename: Josh C
authors.initials: JC
authors.lastname: Denny
mesh_terms: D000046:Academic Medical Centers; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records / Q000592:standards / Q000639:trends; D005838:Genotype; D006284:Health Plan Implementation; D006801:Humans; D010597:Pharmacogenetics; D010641:Phenotype; D057170:Translational Research, Biomedical