Integrating genetic info into CDS alert can reduce adverse drug events


Incorporating genetics testing information into an electronic health record's clinical decision support (CDS) system can reduce adverse medication reactions, according to a study in the Journal of the American Medical Informatics Association (JAMIA).

Adding pharmacogenomic principles to EHRs can improve patient care. Moreover, several medications require the use of pharmacogenomic testing before a patient starts the drug. Therefore, it would be useful for an EHR’s CDS to integrate pharmacogenomic data so that it can be used in clinical practice.

The researchers, from Boston Children’s Hospital, created an automated system to report genetic testing results, such as thiopurine methyltransferase (TPMT) enzyme deficiency to the EHR. The system also issued reports that were automatically emailed to specially trained pharmacists when results were posted in the EHR to identify genetic variant problems on the patient problem list when affected medications were ordered.

Once published to the problem list, the CDS would fire off an alert if a prescriber ordered a related medication, recommending action to incorporate the genotype information into the prescribing decision. Alerts were only activated on medications that had been determined to be significantly affected by the genotype status in order to reduce alert fatigue.

During the study period, from August 2012 through August 2014, 394 patients had TPMT single gene sequencing and 38 were found with TMPT enzyme deficiency, which was added to their problem lists in the EHR. The TPMT alert fired for 31 of them, for a total of 160 times. In response to the alert, 71 percent of prescribers modified the dose being prescribed, and 23 percent cancelled the order.

“As the field progresses and the knowledge base expands, healthcare providers will be expected to consider [genetic] implications at the individual patient level. ... The incorporation of [this] data at the time of prescribing and dispensing, if done correctly, has the potential to impact the incidence of adverse drug events, a significant cause of morbidity and mortality,” the researchers concluded.

To learn more:
- here's the abstract

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