Abstract
BackgroundPharmacogenomic clinical decision support systems (CDSS) have the potential to help overcome some of the barriers for translating pharmacogenomic knowledge into clinical routine. Before developing a prototype it is crucial for developers to know which pharmacogenomic CDSS features and user-system interactions have yet been developed, implemented and tested in previous pharmacogenomic CDSS efforts and if they have been successfully applied. We address this issue by providing an overview of the designs of user-system interactions of recently developed pharmacogenomic CDSS.MethodsWe searched PubMed for pharmacogenomic CDSS published between January 1, 2012 and November 15, 2016. Thirty-two out of 118 identified articles were summarized and included in the final analysis. We then compared the designs of user-system interactions of the 20 pharmacogenomic CDSS we had identified.ResultsAlerts are the most widespread tools for physician-system interactions, but need to be implemented carefully to prevent alert fatigue and avoid liabilities. Pharmacogenomic test results and override reasons stored in the local EHR might help communicate pharmacogenomic information to other internal care providers. Integrating patients into user-system interactions through patient letters and online portals might be crucial for transferring pharmacogenomic data to external health care providers. Inbox messages inform physicians about new pharmacogenomic test results and enable them to request pharmacogenomic consultations. Search engines enable physicians to compare medical treatment options based on a patient’s genotype.ConclusionsWithin the last 5 years, several pharmacogenomic CDSS have been developed. However, most of the included articles are solely describing prototypes of pharmacogenomic CDSS rather than evaluating them. To support the development of prototypes further evaluation efforts will be necessary. In the future, pharmacogenomic CDSS will likely include prediction models to identify patients who are suitable for preemptive genotyping.
Highlights
Pharmacogenomic clinical decision support systems (CDSS) have the potential to help overcome some of the barriers for translating pharmacogenomic knowledge into clinical routine
Six out of the remaining 38 publications were excluded for not describing the design of the user-system interaction of their pharmacogenomic CDSS (Fig. 1)
The 32 publication which had been included were grouped by the fact of whether or not they used a common pharmacogenomic CDSS
Summary
Pharmacogenomic clinical decision support systems (CDSS) have the potential to help overcome some of the barriers for translating pharmacogenomic knowledge into clinical routine. Prominent examples are the anticoagulants clopidogrel and warfarin that are metabolized by CYP2C19 and CYP2C9, respectively Variants in these enzymes can alter the plasma levels of the anticoagulants and thereby lead to insufficient anticoagulation or increased risk of bleeding. An example for the development of pharmacogenomic recommendations and best practices guidelines is the publicly available webbased knowledge base PharmGKB (https://www.pharmgkb.org/). It includes dosing guidelines by the Clinical Pharmacogenetics Implementation Consortium (CPIC), the Royal Dutch Association for the Advancement of Pharmacy - Pharmacogenetics Working Group (DPWG), the Canadian Pharmacogenomics Network for Drug Safety (CPNDS) and other professional society. Other examples of pharmacogenomic knowledge bases are the OncoKB (oncokb.org/#/) by the Memorial Sloan Kettering Cancer Center and the PMKB (https://pmkb.weill.cornell.edu/) by the Weil Cornell Medical College
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