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Hicks, J. K., Dunnenberger, H. M., Gumpper, K. F., Haidar, C. E., & Hoffman, J. M. (2016). Integrating pharmacogenomics into electronic health records with clinical decision support. American Journal Of Health-System Pharmacy, 73(23), 1967-1976. doi:10.2146/ajhp160030

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https://ezproxy.uttyler.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120130973&site=ehost-live&scope=site

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Two main type of alerts are considered: Pre-test Alert- used when no genotype results are available at the time of prescribing.  This alert notifies Physician (MD) of prescribed medication affected by pharmacogenomics variation and the genotype not documented in the EMR. The alert informs MD of potential medication risks to a patient with a high-risk phenotype and will provide an alternative agent. This alert will also allow MD to order a genotype test. Post-test Alert-  triggered when a patient with a high-risk genotype is prescribed a medication that needs to be modified. This alert will also name the potential problems that could occur.These two active decision making tools incorporated into the EMR assures prescribing the most appropriate drug based on the individual and their inherited genetic profile.   

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Two main type of alerts are considered: Pre-test Alert- used when no genotype results are available at the time of prescribing.  This alert notifies Physician (MD) of prescribed medication affected by pharmacogenomics variation and the genotype not documented in the EMR. The alert informs MD of potential medication risks to a patient with a high-risk phenotype and will provide an alternative agent. This alert will also allow MD to order a genotype test. Post-test Alert-  triggered when a patient with a high-risk genotype is prescribed a medication that needs to be modified. This alert will also name the potential problems that could occur.These two active decision making tools incorporated into the EMR assures prescribing the most appropriate drug based on the individual and their inherited genetic profile.   

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Health care precision particularly pharmaceutical using a pharmacogenomic-oriented electronic medical record (EMR) aims to maintain awareness to guide drug selection and dosing into routine patient care. Multiple genes influence a body’s response to or effects of drug therapy.

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Pharmacogenomics data can have clinical use throughout a patient’s whole life. This data can influence future individualized drug selection and dosing which can optimize therapy. Pharmacogenomics takes away the guessing game regarding a medications potential benefits.

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The ever-changing and evolving nature of genomic data needs an informatics team to build a database that can be updated and modified when new evidence emerges.  Interpretation of the data can be complex, therefore substantial institutional effort is required which raises a cost question.

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I have a personal investment in the use of pharmacogenomics. I was the nurse of a patient who underwent quadruple bypass. After his discharge, the appropriate anti-coagulants were ordered and his recovery was successful. Soon after he went home, he suffered another heart attack.  The Cardiovascular Surgeons were indeed confused.  Numerous tests were completed with pharmacogenomics added and the results showed the patient was not responding to the anticoagulants because of his genotype.  He was prescribed the appropriate anticoagulant and has been symptom free. Had our institution implemented the use of pharmacogenomics, my patient’s second heart attack could have been avoided.