Electronic health record design and implementation for pharmacogenomics: a local perspective.

Purpose: The design of electronic health records to translate genomic medicine into clinical care is crucial to successful introduction of new genomic services, yet there are few published guides to implementation.

Methods: The design, implemented features, and evolution of a locally developed electronic health record that supports a large pharmacogenomics program at a tertiary-care academic medical center was tracked over a 4-year development period.

Results: Developers and program staff created electronic health record mechanisms for ordering a pharmacogenomics panel in advance of clinical need (preemptive genotyping) and in response to a specific drug indication.

Identifying unpredicted drug benefit through query of patient experiential knowledge: a proof of concept web-based system.

Information necessary to recognize unexpected drug efficacy is not routinely collected. Once a drug is approved, opportunities for understanding these phenomena are usually lost within clinical care. We propose that patients are willing to provide a wide range of experiential knowledge about the effects of therapies that is seldom solicited.

Extending closed-loop control to the management of chronic disease.

A closed-loop control process assures that a system performs within control limits by direct feedback of the system's output to change the system's inputs. We developed methods for the closed-loop control of system-based practice, using ventilator management as a model or test bed. The control system has three components: 1) an explicit end-to-end plan; 2) a record of what is done as it is done; and 3) an instant display of the status of each patient against the plan for that patient.

Behind-the-scenes of patient-centered care: content analysis of electronic messaging among primary care clinic providers and staff.

Background: Transitions to patient-centered health care, the increasing complexity of care, and growth in self-management have all increased the frequency and intensity of clinical services provided outside office settings and between visits. Understanding how electronic messaging, which is often used to coordinate care, affects care is crucial. A taxonomy for codifying clinical text messages into standardized categories could facilitate content analysis of work performed or enhanced via electronic messaging.

Integrating automated patient letter generation into the electronic medical record.

This poster describes the design and functionality of StarLetter, an electronic patient letter generation tool. StarLetter is integrated into the new results feature of the electronic medical record front end allowing the clinicians to generate electronic letters to patients within their workflow.