Clinician adherence to pharmacogenomics prescribing recommendations in clinical decision support alerts
Thoughtful integration of interruptive clinical decision support (CDS) alerts within the electronic health record is essential to guide clinicians on the application of pharmacogenomic results at point of care. St. Jude Children's Research Hospital implemented a preemptive pharmacogenomic testi...
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| Veröffentlicht in: | Journal of the American Medical Informatics Association : JAMIA 2022-12, Vol.30 (1), p.132-138 |
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| container_title | Journal of the American Medical Informatics Association : JAMIA |
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| creator | Nguyen, Jenny Q Crews, Kristine R Moore, Ben T Kornegay, Nancy M Baker, Donald K Hasan, Murad Campbell, Patrick K Dean, Shannon M Relling, Mary V Hoffman, James M Haidar, Cyrine E |
| description | Thoughtful integration of interruptive clinical decision support (CDS) alerts within the electronic health record is essential to guide clinicians on the application of pharmacogenomic results at point of care. St. Jude Children's Research Hospital implemented a preemptive pharmacogenomic testing program in 2011 in a multidisciplinary effort involving extensive education to clinicians about pharmacogenomic implications. We conducted a retrospective analysis of clinicians' adherence to 4783 pharmacogenomically guided CDS alerts that triggered for 12 genes and 60 drugs. Clinicians adhered to the therapeutic recommendations provided in 4392 alerts (92%). In our population of pediatric patients with catastrophic illnesses, the most frequently presented gene/drug CDS alerts were TPMT/NUDT15 and thiopurines (n = 3850), CYP2D6 and ondansetron (n = 667), CYP2D6 and oxycodone (n = 99), G6PD and G6PD high-risk medications (n = 51), and CYP2C19 and proton pump inhibitors (omeprazole and pantoprazole; n = 50). The high adherence rate was facilitated by our team approach to prescribing and our collaborative CDS design and delivery. |
| doi_str_mv | 10.1093/jamia/ocac187 |
| format | Article |
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St. Jude Children's Research Hospital implemented a preemptive pharmacogenomic testing program in 2011 in a multidisciplinary effort involving extensive education to clinicians about pharmacogenomic implications. We conducted a retrospective analysis of clinicians' adherence to 4783 pharmacogenomically guided CDS alerts that triggered for 12 genes and 60 drugs. Clinicians adhered to the therapeutic recommendations provided in 4392 alerts (92%). In our population of pediatric patients with catastrophic illnesses, the most frequently presented gene/drug CDS alerts were TPMT/NUDT15 and thiopurines (n = 3850), CYP2D6 and ondansetron (n = 667), CYP2D6 and oxycodone (n = 99), G6PD and G6PD high-risk medications (n = 51), and CYP2C19 and proton pump inhibitors (omeprazole and pantoprazole; n = 50). The high adherence rate was facilitated by our team approach to prescribing and our collaborative CDS design and delivery.</description><identifier>ISSN: 1067-5027</identifier><identifier>EISSN: 1527-974X</identifier><identifier>DOI: 10.1093/jamia/ocac187</identifier><identifier>PMID: 36228116</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Brief Communication ; Child ; Cytochrome P-450 CYP2D6 - genetics ; Decision Support Systems, Clinical ; Electronic Health Records ; Humans ; Pharmacogenetics - methods ; Retrospective Studies</subject><ispartof>Journal of the American Medical Informatics Association : JAMIA, 2022-12, Vol.30 (1), p.132-138</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c278t-acdf1025778702c92c6e8a1002406a538b3020c1d0dabb3ce62621c7b66b9ffb3</citedby><cites>FETCH-LOGICAL-c278t-acdf1025778702c92c6e8a1002406a538b3020c1d0dabb3ce62621c7b66b9ffb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9748527/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9748527/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36228116$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nguyen, Jenny Q</creatorcontrib><creatorcontrib>Crews, Kristine R</creatorcontrib><creatorcontrib>Moore, Ben T</creatorcontrib><creatorcontrib>Kornegay, Nancy M</creatorcontrib><creatorcontrib>Baker, Donald K</creatorcontrib><creatorcontrib>Hasan, Murad</creatorcontrib><creatorcontrib>Campbell, Patrick K</creatorcontrib><creatorcontrib>Dean, Shannon M</creatorcontrib><creatorcontrib>Relling, Mary V</creatorcontrib><creatorcontrib>Hoffman, James M</creatorcontrib><creatorcontrib>Haidar, Cyrine E</creatorcontrib><title>Clinician adherence to pharmacogenomics prescribing recommendations in clinical decision support alerts</title><title>Journal of the American Medical Informatics Association : JAMIA</title><addtitle>J Am Med Inform Assoc</addtitle><description>Thoughtful integration of interruptive clinical decision support (CDS) alerts within the electronic health record is essential to guide clinicians on the application of pharmacogenomic results at point of care. St. Jude Children's Research Hospital implemented a preemptive pharmacogenomic testing program in 2011 in a multidisciplinary effort involving extensive education to clinicians about pharmacogenomic implications. We conducted a retrospective analysis of clinicians' adherence to 4783 pharmacogenomically guided CDS alerts that triggered for 12 genes and 60 drugs. Clinicians adhered to the therapeutic recommendations provided in 4392 alerts (92%). In our population of pediatric patients with catastrophic illnesses, the most frequently presented gene/drug CDS alerts were TPMT/NUDT15 and thiopurines (n = 3850), CYP2D6 and ondansetron (n = 667), CYP2D6 and oxycodone (n = 99), G6PD and G6PD high-risk medications (n = 51), and CYP2C19 and proton pump inhibitors (omeprazole and pantoprazole; n = 50). The high adherence rate was facilitated by our team approach to prescribing and our collaborative CDS design and delivery.</description><subject>Brief Communication</subject><subject>Child</subject><subject>Cytochrome P-450 CYP2D6 - genetics</subject><subject>Decision Support Systems, Clinical</subject><subject>Electronic Health Records</subject><subject>Humans</subject><subject>Pharmacogenetics - methods</subject><subject>Retrospective Studies</subject><issn>1067-5027</issn><issn>1527-974X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUFr3DAQhUVoSNK0x16Ljr24K43XkvdSKEuSFgK5JJCbGI_Hu1psyZW8hfz7OJttaE4zzDy-Gd4T4otW37ValYsdDh4XkZB0bU_Eha7AFiu7fPww98rYolJgz8XHnHdKaQNldSbOSwNQa20uxGbd--DJY5DYbjlxIJZTlOMW04AUNxzi4CnLMXGm5BsfNjIxxWHg0OLkY8jSB0kHDPayZfJ5nsq8H8eYJok9pyl_Eqcd9pk_H-uleLi-ul__Km7vbn6vf94WBLaeCqS20woqa2urgFZAhmvUSsFSGazKuikVKNKtarFpSmIDBjTZxphm1XVNeSl-vHLHfTNwSxymhL0bkx8wPbmI3r3fBL91m_jXzZbVs3Uz4NsRkOKfPefJDT4T9z0GjvvswEIFamk1zNLiVUop5py4ezujlXsJxx3CccdwZv3X_397U_9Lo3wGlAqQrw</recordid><startdate>20221213</startdate><enddate>20221213</enddate><creator>Nguyen, Jenny Q</creator><creator>Crews, Kristine R</creator><creator>Moore, Ben T</creator><creator>Kornegay, Nancy M</creator><creator>Baker, Donald K</creator><creator>Hasan, Murad</creator><creator>Campbell, Patrick K</creator><creator>Dean, Shannon M</creator><creator>Relling, Mary V</creator><creator>Hoffman, James M</creator><creator>Haidar, Cyrine E</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20221213</creationdate><title>Clinician adherence to pharmacogenomics prescribing recommendations in clinical decision support alerts</title><author>Nguyen, Jenny Q ; Crews, Kristine R ; Moore, Ben T ; Kornegay, Nancy M ; Baker, Donald K ; Hasan, Murad ; Campbell, Patrick K ; Dean, Shannon M ; Relling, Mary V ; Hoffman, James M ; Haidar, Cyrine E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c278t-acdf1025778702c92c6e8a1002406a538b3020c1d0dabb3ce62621c7b66b9ffb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Brief Communication</topic><topic>Child</topic><topic>Cytochrome P-450 CYP2D6 - genetics</topic><topic>Decision Support Systems, Clinical</topic><topic>Electronic Health Records</topic><topic>Humans</topic><topic>Pharmacogenetics - methods</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nguyen, Jenny Q</creatorcontrib><creatorcontrib>Crews, Kristine R</creatorcontrib><creatorcontrib>Moore, Ben T</creatorcontrib><creatorcontrib>Kornegay, Nancy M</creatorcontrib><creatorcontrib>Baker, Donald K</creatorcontrib><creatorcontrib>Hasan, Murad</creatorcontrib><creatorcontrib>Campbell, Patrick K</creatorcontrib><creatorcontrib>Dean, Shannon M</creatorcontrib><creatorcontrib>Relling, Mary V</creatorcontrib><creatorcontrib>Hoffman, James M</creatorcontrib><creatorcontrib>Haidar, Cyrine E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Medical Informatics Association : JAMIA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nguyen, Jenny Q</au><au>Crews, Kristine R</au><au>Moore, Ben T</au><au>Kornegay, Nancy M</au><au>Baker, Donald K</au><au>Hasan, Murad</au><au>Campbell, Patrick K</au><au>Dean, Shannon M</au><au>Relling, Mary V</au><au>Hoffman, James M</au><au>Haidar, Cyrine E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinician adherence to pharmacogenomics prescribing recommendations in clinical decision support alerts</atitle><jtitle>Journal of the American Medical Informatics Association : JAMIA</jtitle><addtitle>J Am Med Inform Assoc</addtitle><date>2022-12-13</date><risdate>2022</risdate><volume>30</volume><issue>1</issue><spage>132</spage><epage>138</epage><pages>132-138</pages><issn>1067-5027</issn><eissn>1527-974X</eissn><abstract>Thoughtful integration of interruptive clinical decision support (CDS) alerts within the electronic health record is essential to guide clinicians on the application of pharmacogenomic results at point of care. St. Jude Children's Research Hospital implemented a preemptive pharmacogenomic testing program in 2011 in a multidisciplinary effort involving extensive education to clinicians about pharmacogenomic implications. We conducted a retrospective analysis of clinicians' adherence to 4783 pharmacogenomically guided CDS alerts that triggered for 12 genes and 60 drugs. Clinicians adhered to the therapeutic recommendations provided in 4392 alerts (92%). In our population of pediatric patients with catastrophic illnesses, the most frequently presented gene/drug CDS alerts were TPMT/NUDT15 and thiopurines (n = 3850), CYP2D6 and ondansetron (n = 667), CYP2D6 and oxycodone (n = 99), G6PD and G6PD high-risk medications (n = 51), and CYP2C19 and proton pump inhibitors (omeprazole and pantoprazole; n = 50). The high adherence rate was facilitated by our team approach to prescribing and our collaborative CDS design and delivery.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>36228116</pmid><doi>10.1093/jamia/ocac187</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Brief Communication Child Cytochrome P-450 CYP2D6 - genetics Decision Support Systems, Clinical Electronic Health Records Humans Pharmacogenetics - methods Retrospective Studies |
| title | Clinician adherence to pharmacogenomics prescribing recommendations in clinical decision support alerts |
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