Operational Implementation of Prospective Genotyping for Personalized Medicine: The Design of the Vanderbilt PREDICT Project

TLDR

The promise of personalized medicine, enabled by increasingly powerful and economical genomic methods, has spurred interest in tailoring care to individual genetic profiles. This study describes the operational implementation of prospective genotyping linked to a clinical decision‑support system to guide individualized care in a large academic health center, representing a first step toward evaluating personalized medicine strategies. The implementation engaged patients and providers, identified actionable genetic variants, ensured assay reliability, integrated data into the electronic medical record, and deployed point‑of‑care decision support, with roughly 3,000 patients—primarily those scheduled for cardiac catheterization—genotyped in one year using a multiplexed platform that included CYP2C19 variants affecting clopidogrel response. Published in Clinical Pharmacology & Therapeutics (2012); 92(1):87–95.

Abstract

The promise of "personalized medicine" guided by an understanding of each individual's genome has been fostered by increasingly powerful and economical methods to acquire clinically relevant information. We describe the operational implementation of prospective genotyping linked to an advanced clinical decision-support system to guide individualized health care in a large academic health center. This approach to personalized medicine entails engagement between patient and health-care provider, identification of relevant genetic variations for implementation, assay reliability, point-of-care decision support, and necessary institutional investments. In one year, approximately 3,000 patients, most of whom were scheduled for cardiac catheterization, were genotyped on a multiplexed platform that included genotyping for CYP2C19 variants that modulate response to the widely used antiplatelet drug clopidogrel. These data are deposited into the electronic medical record (EMR), and point-of-care decision support is deployed when clopidogrel is prescribed for those with variant genotypes. The establishment of programs such as this is a first step toward implementing and evaluating strategies for personalized medicine. Clinical Pharmacology & Therapeutics (2012); 92 1, 87–95. doi:10.1038/clpt.2011.371