Implementation of Clinical Pharmacogenomics within a Large Health System: From Electronic Health Record Decision Support to Consultation Services by Sissung et al. discusses the experience of the Cleveland Clinic with pharmacogenetic (PGx) implementation as well as how a collaboration between pharmacists and physician-geneticists established an ambulatory PGx clinic to provide testing, interpretation, prescribing recommendations, and patient education. The authors go on to discuss how the implementation of three CPIC guidelines (HLA-B*57:01 and abacavir and HLA-B*15:02 and carbamazepine and TPMT and thiopurines) was managed by pharmacists that incorporated patient data into electronic health records (EHR) who developed clinical decision support tools (CDS) based on CPIC guidelines and included custom pre- and post-test alerts. The selection of which guidelines to implement was based on third-party payment reimbursement for genetic tests, the life-threatening nature of potential adverse events as recognized by the Food and Drug Administration (FDA) in drug labels and physician support.
Pharmacogenomics Implementation at the National Institutes of Health Clinical Center also by Sissung et al. reviews the PGx implementation process at the National Institutes of Health Clinical Center (NIH CC), which uses the recommendations of CPIC guidelines to inform the selection of gene-drug pairs to be implemented. The NIH CC has already implemented PGx testing and prescribing recommendations for HLA-B alleles with allopurinol, abacavir, and carbamazepine, and it is currently in the process of PGx implementation for genes involved in the absorption, distribution, metabolism, or excretion (ADME) of drugs using the DMET genotyping platform. The NIH CC model makes PGx testing, results and recommendations available to all NIH clinicians and also makes test results available to patients and their personal care physicians. The NIH CC expects to cover all CPIC gene-drug pairs within the next five years.
Additional guidelines can be found on the CPIC and PharmGKB and additional information about drugs and genes can also be found on PharmGKB.