Practical considerations in genomic decision support: The eMERGE experience.

Area of Science:

• Genomic Medicine
• Clinical Informatics
• Translational Science

Background:

• Genomic medicine offers personalized treatment strategies, with pharmacogenomics (PGx) identified as a key area for implementation.
• Clinical Decision Support (CDS) systems are crucial for integrating PGx at the point of care.
• While theoretical models exist, practical experiences and challenges of PGx CDS implementation are less documented.

Purpose of the Study:

• To analyze real-world experiences of implementing pharmacogenomics Clinical Decision Support (PGx CDS).
• To identify unanticipated challenges encountered during PGx CDS implementation across multiple healthcare sites.
• To assess the feasibility and common barriers in integrating genomic data into clinical workflows.

Main Methods:

• Analysis of implementation experiences from eleven sites within the Electronic Medical Records and Genomics (eMERGE) Network.
• Examination of PGx CDS system characteristics.
• Survey of sites to identify unanticipated implementation challenges.

Main Results:

• Ten sites successfully implemented at least one PGx CDS rule.
• Most sites utilized an Omic Ancillary System (OAS) for managing genomic data.
• Common and impactful delays were attributed to general IT issues like team coordination and staffing, rather than PGx-specific problems, leading to a median go-live delay of two months.

Conclusions:

• Barriers to PGx CDS implementation are surmountable.
• PGx CDS implementation challenges are comparable to other healthcare IT projects.
• These findings encourage institutions to pursue PGx CDS implementation for advancing genomic medicine.