title: Integrating pharmacogenomics into electronic health records with clinical decision support.
abstract: OBJECTIVE
  Existing pharmacogenomic informatics models, key implementation steps, and emerging resources to facilitate the development of pharmacogenomic clinical decision support (CDS) are described.
  
  
  CONCLUSIONS
  Pharmacogenomics is an important component of precision medicine. Informatics, especially CDS in the electronic health record (EHR), is a critical tool for the integration of pharmacogenomics into routine patient care. Effective integration of pharmacogenomic CDS into the EHR can address implementation challenges, including the increasing volume of pharmacogenomic clinical knowledge, the enduring nature of pharmacogenomic test results, and the complexity of interpreting results. Both passive and active CDS provide point-of-care information to clinicians that can guide the systematic use of pharmacogenomics to proactively optimize pharmacotherapy. Key considerations for a successful implementation have been identified; these include clinical workflows, identification of alert triggers, and tools to guide interpretation of results. These considerations, along with emerging resources from the Clinical Pharmacogenetics Implementation Consortium and the National Academy of Medicine, are described.
  
  
  CONCLUSIONS
  The EHR with CDS is essential to curate pharmacogenomic data and disseminate patient-specific information at the point of care. As part of the successful implementation of pharmacogenomics into clinical settings, all relevant clinical recommendations pertaining to gene-drug pairs must be summarized and presented to clinicians in a manner that is seamlessly integrated into the clinical workflow of the EHR. In some situations, ancillary systems and applications outside the EHR may be integrated to augment the capabilities of the EHR.
authors.affiliation: DeBartolo Family Personalized Medicine Institute and Department of Population Sciences, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Hicks
authors.affiliation: Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Dunnenberger
authors.affiliation: Department of Pharmacy, Boston Children's Hospital, Boston, MA.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Gumpper
authors.affiliation: Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Cyrine E
authors.initials: CE
authors.lastname: Haidar
authors.affiliation: Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN. james.hoffman@stjude.org.
authors.forename: James M
authors.initials: JM
authors.lastname: Hoffman
mesh_terms: D020000:Decision Support Systems, Clinical / Q000639:trends*; D057286:Electronic Health Records / Q000639:trends*; D006801:Humans; D010597:Pharmacogenetics / Q000379:methods / Q000639:trends*; D019095:Point-of-Care Systems / Q000639:trends; D057285:Precision Medicine / Q000379:methods / Q000639:trends
keywords: Clinical Pharmacogenetics Implementation Consortium (CPIC); clinical decision support systems; electronic health records; pharmacogenomics; precision medicine