TABLE 2.
Logistics of implementing PGx testing in paediatrics
| Issue | Challenge | Potential solution |
|---|---|---|
| Indication for PGx testing | Clinicians and pharmacists may feel uncertain when testing is required | Clear paediatric PGx guidelines with integration into electronic prescribing systems and protocols, with PGx champions in each clinical area |
| Reporting | Insufficient standardisation of PGx reports will impede interpretation and use of results | Standardised PGx report format, with educational modules to support prescribers, and local PGx web portal and helpline for queries |
| PGx result transfer | Inadequate mechanisms for data transfer/retention between different healthcare IT systems | Unified or interoperable EHRs between primary and secondary care and pharmacists in which PGx data is stored life long |
| Data retention | PGx results may get lost and the information will not be retained in the patient's lifelong EHR | Use of PGx cards or PGx QR codes linked to smartphone app (compatible with national health systems) and IT to enable linkage to local/centralised lifelong EHR |
| Data curation | Research updating PGx knowledge will not be checked against historical PGx results | PGx data repositories will allow original data to be revisited and reports updated periodically |
| Accountability | Prescribers including physicians, pharmacists, nurse prescribers, may not know how to use PGx information and it will be wasted | Proactive multidisciplinary education with CDS tools embedded in e‐prescribing software alerting prescribers to actionable PGx variants |
| Coding | PGx testing and results are not linked to appropriate standardised clinical coding terms | Coding dictionaries need to be updated in discussion with PGx experts |
| Cost | It is unclear who should pay for PGx testing | Cost allocations need predefining during implementation planning |
| Cascade testing | There are ethical issues surrounding the implications for family members once actionable PGx results are known | Guidelines and SOPs should clarify when testing of a patient's relatives is recommended and how this will be communicated to relevant parties |
Abbreviations: PGx, pharmacogenomics; EHR, electronic health record; QR, quick response; CDS, clinical decision support; SOP, standard operating procedure.