Pharmacogenomics can be defined as the study of variations of DNA and RNA characteristics as related to drug response.  Increasing evidence indicates that human genetic variation modulates drug responses and may help predict whether an individual will have the expected response, an adverse response or no response to a drug.  Increasingly, genetic variations that influence drug response are being identified and can be routinely sought in clinical laboratories.  In the United States, an estimated one in seven hospitalizations are complicated by adverse drug reactions (ADRs), and approximately 700,000 emergency department visits are a result of ADRs¹.  Accordingly, compelling arguments support the use of information on genetic variation to guide the choice of medications and dosages.  The development of electronic medical records (EMRs) facilitates the dissemination of this information to prescribers.

At Mayo Clinic, a pharmacogenomics task force selects drug-gene pairs for inclusion in the EMR.  This interdisciplinary group contributes to the multi-faceted process and includes educators, information technology experts and content experts.  Pharmacists and physicians work cooperatively to develop educational content.   A principal approach used is “just in time” education. When a prescription for a drug is prescribed, an alert is triggered in the EMR.  The alert describes the interaction, which gene test should be considered and why, or indicates whether there is a test result for review.  A link is provided to an education resource called Ask Mayo Expert for additional information about the drug-gene interaction wherein frequently asked questions are answered.  In addition, names and contact information for content experts available for consultation are provided.  The information of the drug-gene interaction is curated and reviewed annually, and updated as needed.

The initial gene-drug pairs have been implemented into the EMR.  Significant effort has been expended to create work-flows which ensure the accurate and efficient provision of this information to prescribers.  Initial feedback from prescribers has been positive.

The process to develop the information and system for the effective provision of drug-gene interactions for prescribers has been enlightening and has required a coordinated, interdisciplinary approach. Pharmacogenomics will play an increasing role in improved effectiveness and safety of drug therapy. Approaches that effectively educate providers at point of care will be critical for the implementation of this information in clinical practice.

The communication of pharmacogenomics information will allow for the fulfillment of the promise of, “right drug, right dose, at the right time” and have an important impact on patient safety.

The authors thank the Center for Individualized Medicine for the use of the video that outlines pharmacogenomics.

1. CDC Medication Safety Program; Davies EC, et al. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One. 2009;4(2):e4439.