A Sanford Imagenetics team advancing the science of pharmacogenetics recently collaborated to write chapters for a textbook that examines how genomic medicine can be translated to clinical practice.
Pharmacogenomics (PGx) is the study of how heredity, or genetics, influences how your body processes certain medications and may help identify a medication that your body is not able to process as expected.
Sanford Health, a national leader in incorporating genetic testing into care for patients, contributed three different chapters in “Clinical Decision Support for Pharmacogenomic Precision Medicine: Foundations and Implementation,” a 296-page book that examines how genomic medicine can be translated to clinical practice.
It was not an easy process but a very worthwhile one, the Sanford authors agreed. Collaboration was a necessity, as was the expertise needed to create material for a book intended to serve as a primer for health systems interested in implementing pharmacogenetic testing programs.
Benefits of an integrated health system
“We’re extremely blessed here at Sanford because we do it all from start to finish,” said Joel Van Heukelom, PharmD, MBA, Imagenetics Pharmacy Supervisor. “We have our own in-house lab so a patient can get their blood drawn here and it goes to the lab and then it comes to us and we help translate it for the end user clinician. It’s all in an enclosed space, so we have good grasp of what it takes. Most institutions probably don’t have that.”
The motivation to contribute to the book was rooted in the authors’ work in pharmacogenomics with Sanford Health. They have a story to tell involving this science and its potential benefits. That story can be told in language best suited for fellow health care professionals, as was the case with the textbook, or to potential patients who may benefit from what remains a relatively new tool in medicine. Either way, it is ultimately the patient who wins.
“Depending on a person’s genetics, some drugs may not be effective for them,” explained Debbie Figueroa, PhD, ABMGG, the Medical Genetics Laboratory Section Director. “They might be prescribed drugs that do not help them at all. That’s why pharmacogenomics is so important. It allows us, before a prescriber gives a drug to a patient, to be able to tell them, ‘Hey, don’t give them this drug, you might actually hurt your patient.’ And it can provide guidance as far as dosage, too.”
Writing the book on PGx
The Sanford team’s contributions addressed several areas in the world of pharmacogenomics and accompanied the work of other writers who were representing some of the nation’s top health care systems. Specifically, Sanford’s team worked on the following chapters:
- Michele Erickson-Johnson, PhD, MB/HCLD, Sanford Health Senior Director, Laboratory Operations and Enterprise Quality, and Dr. Figueroa helped put together the third chapter of the book, titled: “Laboratory Considerations for Pharmacogenomics Testing.”
- April Schultz, PharmD, Imagenetics Operations and Pharmacogenomic Services Director; Amanda Massmann, PharmD, Imagenetics Lead Clinical Pharmacogenomics Pharmacist; and Dr. Van Heukelom all contributed to Chapter 8 titled “Clinical Considerations for Precision Medicine Clinical Decision Support.”
- Massmann, Schultz and Van Heukelom also contributed to Chapter 12, titled “Integration of Clinical Decision Support Infrastructure and Translating into Real-World Applications.”
In each chapter, cooperation and communication were vital in producing a cohesive final product. That was necessary in a paragraph-by-paragraph sense, but also in the overall flow of the book.
“We got together as a team and decided who was going to work on what,” Dr. Erickson-Johnson said. “We broke off and worked on it independently for a while, then we’d come back together and make sure that we were all on the same track and writing for the same purpose and the same reasons.”
How the book evolved
The venture began when Dr. Schultz was contacted by the book’s editors (Drs. Beth Devine, Richard Boyce and Kristin Wiisanen) about the possibility of contributing, along with Sanford pharmacists, to a chapter regarding a lab’s role in delivering pharmacogenomic-based care.
“As a pharmacist I said no to the laboratory expertise but, I told them, I knew some people who might be interested who work in our lab,” Dr. Schultz said, referring to the experts in the Sanford Molecular Genetics Laboratory. “And then I told them that our pharmacy team also has an extensive knowledge base when it comes to the clinical decision support pieces and how to apply those.”
Eventually, after conversations about the book’s overall content, the editors gave the Sanford authors free rein in deciding what they wanted to contribute to the book. That led to creation of three topics, including the last chapter summarizing what pharmacogenetics testing might look like from a patient perspective.
“We really needed to keep remembering the audience that we were speaking to,” Dr. Erickson-Johnson said. “You get so far inside your head sometimes from a writing standpoint, you have to ask yourself, ‘Now would that make sense to somebody who doesn’t work in a lab?’”
The writers regularly reviewed colleagues’ work to ensure their prose was accessible to health care professionals outside the world of pharmacogenomics. It was a part of the process, which they agreed improved the quality of the final product.
To that end, in Chapter 12, the team created a typical patient and then followed that patient through different scenarios.
“We showed how to utilize the information contained in the rest of the book,” Dr. Schultz said. “We went from the time you have your blood taken in the lab through to the time the results are in the doctor’s hands.”
‘Sanford truly cares’
Assembling the chapters was difficult but ultimately rewarding. Several authors joked about how, in the days after completing the writing, they resolved to avoid similar projects in the future. They have since come to value the accomplishment.
“During the process it was like, ‘We’re never doing this ever again,’” Dr. Massmann said, laughing. “But now that we’re down the road, when we look at the finished product, we talk about all the different people we collaborated with and how much we all learned.”
One of the things they were happy to learn was the nationwide regard the medical profession has for the work being done by Sanford Imagenetics. Being asked to be part of the book was in itself a huge compliment. Delivering on it was the reward.
“The Imagenetics Genetic Medicine initiative shows that Sanford truly cares about the well-being of its patients,” Dr. Van Heukelom said. “Sanford is willing to invest in this to allow us to take better care of individuals who are being treated within our walls. We’re investing in better outcomes.”
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