J Am Med Inform Assoc - Integrating pharmacogenetic information and clinical decision support into the electronic health record.

Tópicos

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Resumo

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.

Resumo Limpo

pharmacogenet pg examin gene variat drug disposit respons toxic nation institut health clinic center nih cc multidepart pharmacogenet test implement committe pgtic establish develop clinic decis support cds algorithm abacavir carbamazepin allopurinol medic human leukocyt antigen hla variant predict sever hypersensit reaction provid pg cds electron health record ehr order entri prevent advers drug event medic logic modul mlm program use implement pg cds ehr mlm check see hla sequencebas gene test order messag regard test status result present absent pend test order display order form mlm determin prescrib can place order place requir overrid reason block place order sinc implement medic order place patient differ prescrib three drug includ pg program prescrib common use overrid reason place order main patient receiv drug without reaction implement cds program success incorpor pg cds nih cc ehr requir coordin interdisciplinari effort ensur smooth activ posit effect patient care prescrib adapt use cds order pg test direct result implement

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