Utilizing a user-centered approach to develop and assess pharmacogenomic clinical decision support for thiopurine methyltransferase

BACKGROUND: A pharmacogenomic clinical decision support tool (PGx-CDS) for thiopurine medications can help physicians incorporate pharmacogenomic results into prescribing decisions by providing up-to-date, real-time decision support. However, the PGx-CDS user interface may introduce errors and promote alert fatigue. The objective of this study was to develop and evaluate a prototype of a PGx-CDS user interface for thiopurine medications with user-centered design methods. METHODS: This study had two phases: In phase I, we conducted qualitative interviews to assess providers' information needs. Interview transcripts were analyzed through a combination of inductive and deductive qualitative analysis to develop design requirements for a PGx-CDS user interface. Using these requirements, we developed a user interface prototype and evaluated its usability (phase II). RESULTS: In total, 14 providers participated: 10 were interviewed in phase I, and seven providers completed usability testing in phase II (3 providers participated in both phases). Most (90%) participants were interested in PGx-CDS systems to help improve medication efficacy and patient safety. Interviews yielded 11 themes sorted into two main categories: 1) health care providers' views on PGx-CDS and 2) important design features for PGx-CDS. We organized these findings into guidance for PGx-CDS content and display. Usability testing of the PGx-CDS prototype showed high provider satisfaction. CONCLUSION: This is one of the first studies to utilize a user-centered design approach to develop and assess a PGx-CDS interface prototype for Thiopurine Methyltransferase (TPMT). This study provides guidance for the development of a PGx-CDS, and particularly for biomarkers such as TPMT

Developing a Prototype System for Integrating Pharmacogenomics Findings into Clinical Practice

Findings from pharmacogenomics (PGx) studies have the potential to be applied to individualize drug therapy to improve efficacy and reduce adverse drug events. Researchers have identified factors influencing uptake of genomics in medicine, but little is known about the specific technical barriers to incorporating PGx into existing clinical frameworks. We present the design and development of a prototype PGx clinical decision support (CDS) system that builds on existing clinical infrastructure and incorporates semi-active and active CDS. Informing this work, we updated previous evaluations of PGx knowledge characteristics, and of how the CDS capabilities of three local clinical systems align with data and functional requirements for PGx CDS. We summarize characteristics of PGx knowledge and technical needs for implementing PGx CDS within existing clinical frameworks. PGx decision support rules derived from FDA drug labels primarily involve drug metabolizing genes, vary in maturity, and the majority support the post-analytic phase of genetic testing. Computerized provider order entry capabilities are key functional requirements for PGx CDS and were best supported by one of the three systems we evaluated. We identified two technical needs when building on this system, the need for (1) new or existing standards for data exchange to connect clinical data to PGx knowledge, and (2) a method for implementing semi-active CDS. Our analyses enhance our understanding of principles for designing and implementing CDS for drug therapy individualization and our current understanding of PGx characteristics in a clinical context. Characteristics of PGx knowledge and capabilities of current clinical systems can help govern decisions about CDS implementation, and can help guide decisions made by groups that develop and maintain knowledge resources such that delivery of content for clinical care is supported

FARMAPRICE: A Pharmacogenetic Clinical decision support system for precise and Cost-Effective Therapy

Pharmacogenetic (PGx) guidelines for the precise dosing and selection of drugs remain poorly implemented in current clinical practice. Among the barriers to the implementation process is the lack of clinical decision support system (CDSS) tools to aid health providers in managing PGx information in the clinical context. The present study aimed to describe the first Italian endeavor to develop a PGx CDSS, called FARMAPRICE. FARMAPRICE prototype was conceived for integration of patient molecular data into the clinical prescription process in the Italian Centro di Riferimento Oncologico (CRO)-Aviano Hospital. It was developed through a coordinated partnership between two high-tech companies active in the computerization of the Italian healthcare system. Introducing FARMAPRICE into the clinical setting can aid physicians in prescribing the most efficacious and cost-effective pharmacological therapy available

Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support

In pursuing personalized medicine, pharmacogenomic (PGx) knowledge may help guide prescribing drugs based on a person’s genotype. Here we evaluate the feasibility of incorporating PGx knowledge, combined with clinical data, to support clinical decision-making by: 1) analyzing clinically relevant knowledge contained in PGx knowledge resources; 2) evaluating the feasibility of a rule-based framework to support formal representation of clinically relevant knowledge contained in PGx knowledge resources; and, 3) evaluating the ability of an electronic medical record/electronic health record (EMR/EHR) to provide computable forms of clinical data needed for PGx clinical decision support. Findings suggest that the PharmGKB is a good source for PGx knowledge to supplement information contained in FDA approved drug labels. Furthermore, we found that with supporting knowledge (e.g. IF age <18 THEN patient is a child), sufficient clinical data exists in University of Washington’s EMR systems to support 50% of PGx knowledge contained in drug labels that could be expressed as rules

Towards a Reference Architecture for Female-Sensitive Drug Management

Due to various biological factors, males and females differ in their response to drug treatment. However, there is still a lack of knowledge of the effects resulting from sex-differences in the medical field, especially due to the issue of underrepresentation of females in clinical studies. Considering severe diseases that are related to the cardiovascular system, which are likely to be perilous, counteracting this lack and emphasizing the need for sex-dependent drug treatment is of high importance. Thus, this research-in-progress paper aims at strengthening the female perspective in drug management by proposing design considerations on IS regarding recommender systems in healthcare for reinforcing shared decision-making and person-centered care. The resulting artefact presented will be a reference architecture with a mobile application as the interface to patients and healthcare professionals as well as a data- driven backend to collect and process data on sex specificity in the medical treatment of cardiovascular diseases (CVD)

Master of Science

thesisLack of information is a serious concern for clinicians. Information resources can address this problem, leading to improvements in decision making and patient outcomes. Genomics is an information-rich domain where searching for information can be complex. For example, most physicians agree that pharmacogenomics can be used to improve the quality of care, and there is evidence that many patients harbor actionable pharmacogenomic variation. However, surveys have shown that physicians feel their knowledge of pharmacogenomics to be inadequate. This represents an information need. A natural approach to meet this need is to provide context-aware access to the precise information needed. The Health Level 7 Context-Aware Knowledge Retrieval Standard, a.k.a the Infobutton, offers a modality to deliver context-aware knowledge into electronic health record (EHR) systems. OpenInfobutton is a reference implementation of this standard that offers an open-source instantiation. In this thesis, we aimed to provide insight into pharmacogenomics information needs and an automated mechanism for addressing these needs. Such work can aid the design of tools that support clinical decisions in genomics

A PERSONAL GENOMIC INFORMATION ANALYSIS AND MANAGEMENT SYSTEM FOR HEALTHCARE PURPOSES

Currently, a large amount of personal genomic data can be generated at an affordable price in a short period of time due to the improvement in the DNA sequencing technologies. Abundant research results on genetic diseases have been published in recent years. Therefore, it is eventually possible to integrate multiple types of information together and apply them into genomic-based personalized healthcare. However, this is still a very challenging task for healthcare professionals because the desired information is hidden in highly complex and heterogeneous genomic data sets and spread in various databases, which were typically created for researchers. In this research project, a personal genomic information management and analysis system is created for healthcare professionals, especially physicians. To properly design such a system, an exploratory survey was conducted to identify the current status of physicians in using genomics in their clinical practice and to collect their expectations about the features of a patient genomic information system. The results of this study indicated that physicians have sufficient knowledge in genomics and they are interested in incorporating genomics into their clinical practice. The results also indicated that a well-designed patient genomic information system with desired features can help physicians to incorporate genomics into their clinical practice. Based on the survey findings, a personal genomic information system was created for the purpose of managing and analyzing patient genomic data. In this system, we first created an integrated database, and then developed data analysis algorithms to extract clinical information from patient genetic variation data, including disease-associated genetic variations and pharmacogenomic associations. Physicians can conveniently identify the genetic reasons for diseases and determine personalized treatment options based on the information provided by the system. A usability study was conducted to obtain physicians’ feedback about the system after they use it to finish some tasks such as searching the genetic variations of one patient, determining the patient’s risk of certain diseases, and identifying the corresponding pharmacogenomic results. The results of this study indicated that physicians could easily find the patient information they need and the information can be directly applied in their clinical practice

A national clinical decision support infrastructure to enable the widespread and consistent practice of genomic and personalized medicine

<p>Abstract</p> <p>Background</p> <p>In recent years, the completion of the Human Genome Project and other rapid advances in genomics have led to increasing anticipation of an era of genomic and personalized medicine, in which an individual's health is optimized through the use of all available patient data, including data on the individual's genome and its downstream products. Genomic and personalized medicine could transform healthcare systems and catalyze significant reductions in morbidity, mortality, and overall healthcare costs.</p> <p>Discussion</p> <p>Critical to the achievement of more efficient and effective healthcare enabled by genomics is the establishment of a robust, nationwide clinical decision support infrastructure that assists clinicians in their use of genomic assays to guide disease prevention, diagnosis, and therapy. Requisite components of this infrastructure include the standardized representation of genomic and non-genomic patient data across health information systems; centrally managed repositories of computer-processable medical knowledge; and standardized approaches for applying these knowledge resources against patient data to generate and deliver patient-specific care recommendations. Here, we provide recommendations for establishing a national decision support infrastructure for genomic and personalized medicine that fulfills these needs, leverages existing resources, and is aligned with the <it>Roadmap for National Action on Clinical Decision Support </it>commissioned by the U.S. Office of the National Coordinator for Health Information Technology. Critical to the establishment of this infrastructure will be strong leadership and substantial funding from the federal government.</p> <p>Summary</p> <p>A national clinical decision support infrastructure will be required for reaping the full benefits of genomic and personalized medicine. Essential components of this infrastructure include standards for data representation; centrally managed knowledge repositories; and standardized approaches for leveraging these knowledge repositories to generate patient-specific care recommendations at the point of care.</p

Doctor of Philosophy

dissertationThe widespread use of genomic information to improve clinical care has long been a goal of clinicians, researchers, and policy-makers. With the completion of the Human Genome Project over a decade ago, the feasibility of attaining this goal on a widespread basis is becoming a greater reality. In fact, new genome sequencing technologies are bringing the cost of obtaining a patient's genomic information within reach of the general population. While this is an exciting prospect to health care, many barriers still remain to effectively use genomic information in a clinically meaningful way. These barriers, if not overcome, will limit the ability of genomic information to provide a significant impact on health care. Nevertheless, clinical decision support (CDS), which entails the provision of patient-specific knowledge to clinicians at appropriate times to enhance health care, offers a feasible solution. As such, this body of work represents an effort to develop a functional CDS solution capable of leveraging whole genome sequence information on a widespread basis. Many considerations were made in the design of the CDS solution in order to overcome the complexities of genomic information while aligning with common health information technology approaches and standards. This work represents an important advancement in the capabilities of integrating actionable genomic information within the clinical workflow using health informatics approaches

User-Centered Software Design: User Interface Redesign for Blockly–Electron, Artificial Intelligence Educational Software for Primary and Secondary Schools

According to the 2021 and 2022 Horizon Report, AI is emerging in all areas of education, in various forms of educational aids with various applications, and is carving out a similarly ubiquitous presence across campuses and classrooms. This study explores a user-centered approach used in the design of the AI educational software by taking the redesign of the user interface of AI educational software Blockly–Electron as an example. Moreover, by analyzing the relationship between the four variables of software usability, the abstract usability is further certified so as to provide ideas for future improvements to the usability of AI educational software. User-centered design methods and attribution analysis are the main research methods used in this study. The user-centered approach was structured around four phases. Overall, seventy-three middle school students and five teachers participated in the study. The USE scale will be used to measure the usability of Blockly–Electron. Five design deliverables and an attribution model were created and discovered in the linear relationship between Ease of Learning, Ease of Use, Usefulness and Satisfaction, and Ease of use as a mediator variable, which is significantly different from the results of previous regression analysis for the USE scale. This study provides a structural user-centered design methodology with quantitative research. The deliverables and the attribution model can be used in the AI educational software design. Furthermore, this study found that usefulness and ease of learning significantly affect the ease of use, and ease of use significantly affects satisfaction. Based on this, the usability will be further concretized to facilitate the production of software with greater usability