title: Physician perspectives of CYP2C19 and clopidogrel drug-gene interaction active clinical decision support alerts.
abstract: OBJECTIVE
  To determine if physicians find clinical decision support alerts for pharmacogenomic drug-gene interactions useful and assess their perceptions of usability aspects that impact usefulness.
  
  
  METHODS
  52 physicians participated in an online simulation and questionnaire involving a prototype alert for the clopidogrel and CYP2C19 drug-gene interaction.
  
  
  RESULTS
  Only 4% of participants stated they would override the alert. 92% agreed that the alerts were useful. 87% found the visual interface appropriate, 91% felt the timing of the alert was appropriate and 75% were unfamiliar with the specific drug-gene interaction. 80% of providers preferred the ability to order the recommended medication within the alert. Qualitative responses suggested that supplementary information is important, but should be provided as external links, and that the utility of pharmacogenomic alerts depends on the broader ecosystem of alerts.
  
  
  CONCLUSIONS
  Pharmacogenomic alerts would be welcomed by many physicians, can be built with minimalist design principles, and are appropriately placed at the end of the prescribing process. Since many physicians lack familiarity with pharmacogenomics but have limited time, information and educational resources within the alert should be carefully selected and presented in concise ways.
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA. Electronic address: adamnish@uw.edu.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Nishimura
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Shirts
authors.affiliation: Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Salama
authors.affiliation: Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Joe W
authors.initials: JW
authors.lastname: Smith
authors.affiliation: Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Devine
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Department of Computer Science and Engineering, University of Washington, Seattle, WA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Tarczy-Hornoch
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics / Q000378:metabolism*; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D004347:Drug Interactions; D004360:Drug Therapy, Computer-Assisted / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D010597:Pharmacogenetics; D010975:Platelet Aggregation Inhibitors / Q000378:metabolism; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017010:Reminder Systems; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000378:metabolism; D014584:User-Computer Interface; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine
keywords: Clinical decision support; Clinical informatics; Electronic medical records; Genomic medicine; Pharmacogenomics