Clinical decision support with a comprehensive in-EHR patient tracking system improves genetic testing follow up

The Use of Precision Medicine to Support the Precision of Clinical Decisions in care delivery

OBJECTIVES

Objective: Precision medicine uses individualized patient data, including genomic and social determinants of health SDoH), to provide optimized personalized patient treatment. In this scoping review, we summarize studies published in the last two years that reported on implementation of precision medicine in clinical decision support (CDS) related to precision medicine.

METHODS

We searched PubMed for manuscripts published in 2022 and 2023 to retrieve publications that included CDS and precision medicine keywords and Mesh terms. We reviewed the abstracts and full texts to apply the inclusion criteria that the study must have described the implementation of precision medicine related CDS within electronic health records. We extracted the domain, type of data used in CDS, target population included in the implementation from the final set of included manuscripts.

RESULTS

Our search retrieved 285 manuscripts and papers. Sixteen (16) papers met inclusion criteria after manual review of the full text. Eight of the reviewed papers studied the successful implementation of pharmacogenomics in CDS, four studies investigated the implementation of disease risk, and only one paper described the implementation of CDS integrating social determinants of health.

CONCLUSION

Our scoping review of recent literature highlighted several findings. Pharmacogenomics is the most implemented precision medicine intervention based on published studies. Few reports describing disease risk and polygenic risk scores were found and no study addressed CDS for continuous biometric monitoring. Despite the increasing attention to social determinants of health as a key predictor of health outcomes, only one CDS incorporating SDoH have been publicly reported. Regular updates to scoping reviews can investigate barriers to implementation and identify solutions.

Genetically guided precision medicine clinical decision support tools: a systematic review

OBJECTIVES

Patient care using genetics presents complex challenges. Clinical decision support (CDS) tools are a potential solution because they provide patient-specific risk assessments and/or recommendations at the point of care. This systematic review evaluated the literature on CDS systems which have been implemented to support genetically guided precision medicine (GPM).

MATERIALS AND METHODS

A comprehensive search was conducted in MEDLINE and Embase, encompassing January 1, 2011-March 14, 2023. The review included primary English peer-reviewed research articles studying humans, focused on the use of computers to guide clinical decision-making and delivering genetically guided, patient-specific assessments, and/or recommendations to healthcare providers and/or patients.

RESULTS

The search yielded 3832 unique articles. After screening, 41 articles were identified that met the inclusion criteria. Alerts and reminders were the most common form of CDS used. About 27 systems were integrated with the electronic health record; 2 of those used standards-based approaches for genomic data transfer. Three studies used a framework to analyze the implementation strategy.

DISCUSSION

Findings include limited use of standards-based approaches for genomic data transfer, system evaluations that do not employ formal frameworks, and inconsistencies in the methodologies used to assess genetic CDS systems and their impact on patient outcomes.

CONCLUSION

We recommend that future research on CDS system implementation for genetically GPM should focus on implementing more CDS systems, utilization of standards-based approaches, user-centered design, exploration of alternative forms of CDS interventions, and use of formal frameworks to systematically evaluate genetic CDS systems and their effects on patient care.