PMID- 24302286
OWN - NLM
STAT- MEDLINE
DCOM- 20140605
LR  - 20211021
IS  - 1527-974X (Electronic)
IS  - 1067-5027 (Print)
IS  - 1067-5027 (Linking)
VI  - 21
IP  - 3
DP  - 2014 May-Jun
TI  - Integrating pharmacogenetic information and clinical decision support into the 
      electronic health record.
PG  - 522-8
LID - 10.1136/amiajnl-2013-001873 [doi]
AB  - Pharmacogenetics (PG) examines gene variations for drug disposition, response, or 
      toxicity. At the National Institutes of Health Clinical Center (NIH CC), a 
      multidepartment Pharmacogenetics Testing Implementation Committee (PGTIC) was 
      established to develop clinical decision support (CDS) algorithms for abacavir, 
      carbamazepine, and allopurinol, medications for which human leukocyte antigen 
      (HLA) variants predict severe hypersensitivity reactions. Providing PG CDS in the 
      electronic health record (EHR) during order entry could prevent adverse drug 
      events. Medical Logic Module (MLM) programming was used to implement PG CDS in 
      our EHR. The MLM checks to see if an HLA sequence-based gene test is ordered. A 
      message regarding test status (result present, absent, pending, or test not 
      ordered) is displayed on the order form, and the MLM determines if the prescriber 
      can place the order, place it but require an over-ride reason, or be blocked from 
      placing the order. Since implementation, more than 725 medication orders have 
      been placed for over 230 patients by 154 different prescribers for the three 
      drugs included in our PG program. Prescribers commonly used an over-ride reason 
      when placing the order mainly because patients had been receiving the drug 
      without reaction before implementation of the CDS program. Successful 
      incorporation of PG CDS into the NIH CC EHR required a coordinated, 
      interdisciplinary effort to ensure smooth activation and a positive effect on 
      patient care. Prescribers have adapted to using the CDS and have ordered PG 
      testing as a direct result of the implementation.
FAU - Goldspiel, Barry R
AU  - Goldspiel BR
AD  - Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, 
      Maryland, USA.
FAU - Flegel, Willy A
AU  - Flegel WA
FAU - DiPatrizio, Gary
AU  - DiPatrizio G
FAU - Sissung, Tristan
AU  - Sissung T
FAU - Adams, Sharon D
AU  - Adams SD
FAU - Penzak, Scott R
AU  - Penzak SR
FAU - Biesecker, Leslie G
AU  - Biesecker LG
FAU - Fleisher, Thomas A
AU  - Fleisher TA
FAU - Patel, Jharana J
AU  - Patel JJ
FAU - Herion, David
AU  - Herion D
FAU - Figg, William D
AU  - Figg WD
FAU - Lertora, Juan J L
AU  - Lertora JJ
FAU - McKeeby, Jon W
AU  - McKeeby JW
LA  - eng
PT  - Journal Article
DEP - 20131203
PL  - England
TA  - J Am Med Inform Assoc
JT  - Journal of the American Medical Informatics Association : JAMIA
JID - 9430800
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Algorithms
MH  - Decision Support Systems, Clinical
MH  - *Drug Therapy, Computer-Assisted
MH  - *Electronic Health Records
MH  - Genotype
MH  - HLA Antigens/genetics
MH  - Humans
MH  - Medical Order Entry Systems
MH  - *Pharmacogenetics
MH  - Precision Medicine/methods
MH  - Systems Integration
MH  - User-Computer Interface
PMC - PMC3994859
OTO - NOTNLM
OT  - Clinical Decision Support
OT  - Computerized Prescriber Order Entry
OT  - Informatics
OT  - Patient Safety
OT  - Pharmacogenetics
EDAT- 2013/12/05 06:00
MHDA- 2014/06/06 06:00
PMCR- 2015/05/01
CRDT- 2013/12/05 06:00
PHST- 2013/12/05 06:00 [entrez]
PHST- 2013/12/05 06:00 [pubmed]
PHST- 2014/06/06 06:00 [medline]
PHST- 2015/05/01 00:00 [pmc-release]
AID - amiajnl-2013-001873 [pii]
AID - 10.1136/amiajnl-2013-001873 [doi]
PST - ppublish
SO  - J Am Med Inform Assoc. 2014 May-Jun;21(3):522-8. doi: 
      10.1136/amiajnl-2013-001873. Epub 2013 Dec 3.