Table 1.

Key Components of CPIC Initiatives

Engaging with Key Stakeholders	Prioritizing Gene-Drug Pairs for Implementation	Selecting a Pharmacogenomics Test	Establishing EHR Infrastructure	Maintaining Sustainability
Identify and engage multidisciplinary institutional champions and stakeholders	Review clinical evidence and select gene-drug pairs with sufficiently strong evidence that warrants clinical implementation	Determine whether a single gene or multigene panel test is most appropriate for the gene-drug pair(s) selected for implementation	Identify methods for discretely curating pharmacogenomics data in the EHR	Develop continuing education for clinicians and patients to sustain ongoing pharmacogenomics efforts
Determine the value proposition of the pharmacogenomics initiative for the institution	Evaluate drug-prescribing frequencies and which providers are prescribing the drugs of interest	Engage with the laboratory medicine department to determine whether genetic testing should be performed internally or specimens sent to a reference laboratory	Collaborate with clinical informatics teams to develop CDS tools that alert clinicians of important genomics information	Maintain and further develop CDS tools to support ongoing pharmacogenomics efforts
Identify potential barriers to implementing clinical pharmacogenomics and formulate solutions	Evaluate the demographics of the patient population and calculate the expected frequencies of actionable genetic variants	Evaluate the demographics of the patient population to determine whether a genetic test provides appropriate coverage, given the expected variant frequencies	Obtain provider input on clinical recommendations found in CDS tools	Perform systematic evaluations of operational metrics and deliverables to demonstrate value
Organize a formal precision medicine or pharmacogenomics oversight committee			Obtain provider input on CDS workflows, including when to use active vs. passive CDS	Integrate pharmacogenomics into institution-specific quality improvement projects
Engage with pharmacy leadership to integrate pharmacogenomics into existing clinical pharmacist services	Align gene-drug pair selection with institutional deliverables and patient care goals	Formulate billing and reimbursement matrices, including the need for a reference laboratory that provides billing services	Establish standard operating procedures for evaluating, maintaining, and updating CDS tools	Communicate findings of value assessments to key stakeholders and institutional leadership
Engage other institutional groups and task forces (e.g., anticoagulation task force, CDS committee, risk management)		Select a test that is suitable for workflow logistics, including turnaround time and specimen type (e.g., blood or buccal swab)
		Verify that a selected laboratory has appropriate state and federal certification/licensure

CDS = clinical decision support; CPIC = Clinical Pharmacogenetics Implementation Consortium; EHR = electronic health record.