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Using pharmacogenetics for safer drug orders

  • Rick Mansour, M.D.
  • 06/10/2014

The SunriseTM platform is unique because we designed it to be a central nervous system of health care organizations. It constantly gathers, aggregates, evaluates and acts on information for optimal clinical decision support.

Our clients are using these capabilities to integrate evidence-based information at the point of care. For example, a team at the U.S. National Institutes of Health Clinical Center (NIH CC) recently developed a program for Sunrise using pharmacogenetics, which evaluates genetic information to predict a patient’s response to medication.

The goal was to provide newly available information at the point of care to help clinicians reduce the risk of adverse drug events. The Journal of American Medical Information Association (JAMIA)* featured this patient safety project in a recent article.

Starting with safety checks for three drugs

The NIH CC team wanted a tool to help clinicians as they place orders for three medications: abacavir, carbamazepine, and allopurinol. They treat different conditions, but the same genetic variant (HLA) can predict severe reactions for all three drugs.

NIH CC developed algorithms, which it integrated directly into the EHR with a Medical Logic Module (MLM) program. As soon as a clinician orders one of these drugs, the MLM checks to see if HLA genetic test results are in the patient’s record.

The clinician can see on the order form if lab results are present, absent, pending, or not ordered. Then the MLM determines if the prescriber can place the order, place it but require an over-ride reason, or be blocked from placing the order.

Now NIH CC clinicians can:

  • Determine if an HLA genetic test occurred and view available results
  • Order HLA test from the EHR
  • Store HLA test results in the EHR
  • Order medications through “order set forms”
  • See everything on a single order entry screen

Since implementation, 154 different prescribers have placed more than 725 medication orders for over 230 patients for these drugs. NIH CC is beginning work to apply algorithms to other medications.

Because Sunrise draws from all of the information available in the EHR and can evaluate it, NIH CC can use MLMs to continually improve this powerful decision support tool. The organization’s pharmacogenetic MLMs provide consistent, automatic checks for potential warning signs. These processes reduce the risk of adverse drug events and keep patients safer.

* Source: “Integrating pharmacogenetic information and clinical decision support into the electronic health record” Barry R Goldspiel, Willy A Flegel, Gary DiPatrizio, et al. J Am Med Inform Assoc 2014; 21:522-528. Originally published online December 3, 2013. doi: 10.1136/amiajnl-2013-001873

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About the author

Rick Mansour, MD, is vice president solutions management for core clinical and departmental solutions at Allscripts. In this role, he combines his medical and software development knowledge for better clinical outcomes. His special interests include clinical decision support programming, Arden Syntax, relational database structure and query language. Prior to joining Allscripts (initially as chief medical information officer for Eclipsys), Dr. Mansour served as chief of hematology and medical oncology at Freidman Clinical Internal Medicine. He also is an associate professor of Medicine and supervises fellows clinic at the Feist-Weiller Cancer Center at LSU Health -Shreveport.

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