Effective CDS could routinely implement personalized medicine
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“The effective realization of GPM remains limited,” wrote Kensaku Kawamoto, MD, PhD, and Brandon M. Welch, both of the department of biomedical informatics and the program in personalized care at the University of Utah in Salt Lake City. “While this is partly due to the need for further evidence of the clinical utility and cost effectiveness of a genetically guided approach to patient care, an important additional reason is the need for information systems that assist in the translation of knowledge from bench to bedside.”
Barriers preventing the realization of GPM include lack of genetic proficiency among clinicians, a limited number of genetics experts and a growing base of genetic knowledge, which has resulted in the development of more than 2,500 clinical genetic tests. CDS could break these barriers, but there’s been little research to date on the health IT tool’s ability to facilitate GPM.
Researchers screened 3,416 research manuscripts published between 1990 and 2011, and included 38 in their review. The majority, however, were published after 2007, indicating a rising interest in GPM that could quicken the arrival of its promise.
Researchers searched MEDLINE and Embase, databases containing peer-reviewed research articles, for content focusing on CDS and genetic health services. More than 3,000 of the results returned by their screening were excluded because their primary focus did not match researchers’ criteria. Other results, such those not in English and those not published in peer-reviewed journals, were also excluded.
Articles included in the final results included nine randomized clinical trials on the impact of CDS systems for GPM, seven articles focused on CDS integration with primary clinical information systems and 16 articles involving the use of genotype to drive CDS.
Most research on CDS applications for GPM focused on cancer treatment and pharmacogenomics, with the rest focusing primarily on CDS application for GPM to treat other conditions. There was a trend away from research focused on family history-driven CDS, which dominated earlier research on the subject, toward genotype-driven CDS in later years.
From their review of the available literature, researchers determined little research demonstrated how genotype-driven CDS can be integrated into clinical systems in a scalable, standards-based and effective manner.
“The promise of GPM is growing with the recent advances and discoveries in genomics research,” the authors concluded. “With this growth also comes the growing need for translating such discoveries into everyday clinical care, so that we are able to realize the promises of GPM.”