When a healthcare provider's project transitions from research into clinical practice, it knows it has turned a corner. University of Florida Health turned that corner in June 2012 with a project that uses genetic testing to identify patients who can't metabolize certain meds.
UF Health created a pilot program around patients entering its cardiac catheterization lab who are prescribed the blood thinner Plavix (clopidogrel). One in four patients can't metabolize clopidogrel, which the lab prescribes to most entering patients.UF Health developed a test that identifies the gene responsible for clopidogrel metabolization and made the test a part of its standing orders.
DNA analyzers generate an overwhelming amount of data, and clinicians don't need most of that data. So UF Health IT pros used data-reduction techniques to format the data into a usable piece of clinical information to answer the original question: Will this drug work on this particular patient? "The struggle with genomics is how to make data readable for physicians who aren't used to dealing with data all the time," says Kari Cassel, UF Health's CIO. "The question is how to make the data relevant."
UF Health's programming team, not academic researchers, took the initial step of transforming single nucleotide proteins into genotypes. It then pushed the genomic test results to UF Health's Epic electronic health record system and created a physician alert for patients who lack the metabolizing gene. The alert, part of Epic's clinical decision support, will suggest alternative drugs. Because the genetic test result is valid for the patient's lifetime, the alert appears in all future visits.
"A lot of alerts we physicians don't know what to do with," says Dr. Don Novak, a pediatrician and assistant dean for clinical informatics at UF. "This is concrete."
In the first seven months of the pilot, UF Health performed the test on 80% of its cardiac cath lab patients -- more than 600 people. One hundred fifty-eight of them had genetic variants that led to a recommendation not to use clopidogrel.
UF Health plans to expand the program to other medical areas, both inpatient and outpatient, in the coming year. "We want the genetic alert to be as simple as any other alert that comes along," CIO Cassel says. "We can now look at this data without jumping through hoops."