title: Multidisciplinary model to implement pharmacogenomics at the point of care.
abstract: Despite potential clinical benefits, implementation of pharmacogenomics (PGx) faces many technical and clinical challenges. These challenges can be overcome with a comprehensive and systematic implementation model.
  
  
  
  The development and implementation of PGx were organized into eight interdependent components addressing resources, governance, clinical practice, education, testing, knowledge translation, clinical decision support (CDS), and maintenance. Several aspects of implementation were assessed, including adherence to the model, production of PGx-CDS interventions, and access to educational resources.
  
  
  
  Between August 2012 and June 2015, 21 specific drug-gene interactions were reviewed and 18 of them were implemented in the electronic medical record as PGx-CDS interventions. There was complete adherence to the model with variable production time (98-392 days) and delay time (0-148 days). The implementation impacted approximately 1,247 unique providers and 3,788 unique patients. A total of 11 educational resources complementary to the drug-gene interactions and 5 modules specific for pharmacists were developed and implemented.
  
  
  
  A comprehensive operational model can support PGx implementation in routine prescribing. Institutions can use this model as a roadmap to support similar efforts. However, we also identified challenges that will require major multidisciplinary and multi-institutional efforts to make PGx a universal reality.Genet Med 19 4, 421-429.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.|Office of Information and Knowledge Management, Rochester, Minnesota, USA.
authors.forename: Pedro J
authors.identifier: 0000-0001-9050-7080
authors.initials: PJ
authors.lastname: Caraballo
authors.affiliation: Center for Individualized Medicine, Rochester, Minnesota, USA.
authors.forename: Lucy S
authors.initials: LS
authors.lastname: Hodge
authors.affiliation: Department of Health Sciences Research, Rochester, Minnesota, USA.
authors.forename: Suzette J
authors.identifier: 0000-0002-2905-5430
authors.initials: SJ
authors.lastname: Bielinski
authors.affiliation: Center for Individualized Medicine, Rochester, Minnesota, USA.
authors.forename: A Keith
authors.initials: AK
authors.lastname: Stewart
authors.affiliation: Center for Individualized Medicine, Rochester, Minnesota, USA.
authors.forename: Gianrico
authors.initials: G
authors.lastname: Farrugia
authors.affiliation: Center for Individualized Medicine, Rochester, Minnesota, USA.
authors.forename: Cloann G
authors.identifier: 0000-0002-0701-9375
authors.initials: CG
authors.lastname: Schultz
authors.affiliation: Center for Individualized Medicine, Rochester, Minnesota, USA.
authors.forename: Carolyn R
authors.identifier: 0000-0003-2371-3022
authors.initials: CR
authors.lastname: Rohrer-Vitek
authors.affiliation: Department of Health Sciences Research, Rochester, Minnesota, USA.
authors.forename: Janet E
authors.identifier: 0000-0003-4944-7789
authors.initials: JE
authors.lastname: Olson
authors.affiliation: Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA.
authors.forename: Jennifer L
authors.identifier: 0000-0002-9789-8544
authors.initials: JL
authors.lastname: St Sauver
authors.affiliation: Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA.
authors.forename: Veronique L
authors.initials: VL
authors.lastname: Roger
authors.affiliation: Office of Information and Knowledge Management, Rochester, Minnesota, USA.|Division of Community Internal Medicine, Jacksonville, Florida, USA.
authors.forename: Mark A
authors.identifier: 0000-0002-4792-7327
authors.initials: MA
authors.lastname: Parkulo
authors.affiliation: Division of Cardiovascular Diseases, Rochester, Minnesota, USA.
authors.forename: Iftikhar J
authors.initials: IJ
authors.lastname: Kullo
authors.affiliation: Department of Anesthesiology, Rochester, Minnesota, USA.
authors.forename: Wayne T
authors.identifier: 0000-0002-3418-4253
authors.initials: WT
authors.lastname: Nicholson
authors.affiliation: Division of Hematology, Rochester, Minnesota, USA.
authors.forename: Michelle A
authors.identifier: 0000-0002-7366-9886
authors.initials: MA
authors.lastname: Elliott
authors.affiliation: Department of Laboratory Medicine and Pathology, Rochester, Minnesota, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Black
authors.affiliation: Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, Minnesota, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Weinshilboum
mesh_terms: D020000:Decision Support Systems, Clinical; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D057286:Electronic Health Records; D006801:Humans; D008962:Models, Theoretical; D010597:Pharmacogenetics / Q000193:education; D019095:Point-of-Care Systems; D057285:Precision Medicine