Abstract
Background/Aims A widely-held vision arising from genomics research is to be able to use information on genomic variation to guide clinical prescriptions. This translational project is designed to test the concept that sequence information from a patient can be coupled with electronic medical records for use in personalized medicine.
Methods Marshfield Clinic is a health care system in Wisconsin with 2 hospitals and 52 community care centers, a member of the HMORN, and partner of the Institute for Clinical and Translational Research, University of Wisconsin – Madison. Cattails, Marshfield Clinic’s internally developed outpatient EHR, has been in existence since the late 1980s. The full-feature EHR is deployed on laptop, tablet and PDA technology and supports a variety of clinical decision support (CDS) applications surrounding care management, prevention, radiology orders and medication prescribing. Much of the underlying infrastructure that supports these CDS applications will be used when integrating genomic information into clinical practice. The underlying development principles for this initiative emphasize the importance of clinical workflow, genetic result significance, and the ability to reconfigure the system as knowledge improves.
Results A strategy of implementing an informatics system to satisfy the needs of pharmacogenetics from both research and clinical practice was tested. One in three of the 411,851 Marshfield Clinic patients in 2011 could benefit from a pharmacogenomic test. Implementing pharmacogenetics tests of three drugs (Warfarin, Clopidogrel, and Tamoxifen) at Marshfield Clinic could prevent potential adverse events that cost $11.3 million annually.
Conclusions Such an informatics system will further enable comparative effectiveness research in pharmacogenetics and pharmacogenomics.
