Barriers and facilitators of the use of clinical informatics resources to facilitate pharmacogenomic implementation in resource-limited settings

Jade Bosic-Reiniger; James L Martin; Karen E Brown; Heather D Anderson; Hayley Blackburn; David P Kao; Katy E Trinkley; Erica L Woodahl; Christina L Aquilante

doi:10.1093/jamiaopen/ooae101

Barriers and facilitators of the use of clinical informatics resources to facilitate pharmacogenomic implementation in resource-limited settings

JAMIA Open. 2024 Oct 12;7(4):ooae101. doi: 10.1093/jamiaopen/ooae101. eCollection 2024 Dec.

Authors

Jade Bosic-Reiniger^{1

2}, James L Martin^{3

4}, Karen E Brown^{1

5}, Heather D Anderson^{4

6}, Hayley Blackburn^{1

2}, David P Kao^{4

7}, Katy E Trinkley⁸, Erica L Woodahl^{1

5}, Christina L Aquilante^{3

4}

Affiliations

¹ L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States.
² Department of Pharmacy Practice, University of Montana, Missoula, MT 59812, United States.
³ Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, United States.
⁴ Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
⁵ Department of Biomedical and Pharmaceutical Sciences, University of Montana Skaggs School of Pharmacy, Missoula, MT 59812, United States.
⁶ Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, United States.
⁷ Division of Cardiology, University of Colorado School of Medicine, Aurora, CO 80045, United States.
⁸ Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO 80045, United States.

Abstract

Objective: Understand perceived barriers to and facilitators of using clinical informatics applications for pharmacogenomic (PGx) implementation in resource-limited settings.

Materials and methods: We conducted a qualitative research study using a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview questions assessed CFIR contextual determinants related to: electronic health record (EHR) infrastructure; clinical informatics personnel and resources; EHR integration of PGx test results; PGx clinical decision support (CDS) tools; institutional resources; and partner receptivity. Transcripts were coded and analyzed to identify themes.

Results: We interviewed 24 clinical informaticists and executive leaders working in rural or underserved health care settings in Montana (n = 15) and Colorado (n = 9) and identified three major themes: (1) EHR infrastructure limitations, (2) insufficient supporting resources, and (3) unique contextual considerations for resource-limited settings. EHR infrastructure limitations included limited agency related to EHR build and interoperability concerns. Theme 1 highlighted challenges associated with integrating structured data into the EHR and inadequate vendor support. Theme 2 included limited familiarity with PGx across the care team, cost concerns, and allocation of non-financial resources. Theme 3 highlighted perceptions about the clinical utility of PGx within rural and underrepresented populations. Potential facilitators, such as being able to act nimbly, were found to coexist among the reported barriers.

Discussion and conclusion: Our results provide insight into the clinical informatics infrastructure in resource-limited settings and identify unique considerations for clinical informatics-facilitated PGx implementation. Future efforts in these settings should consider innovative partnerships and strategies to leverage facilitators and minimize barriers associated with integrating PGx CDS applications.

Keywords: clinical informatics; implementation; pharmacogenetics; pharmacogenomics; rural; underserved populations.