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Abstract: Background: Pharmacogenomic Clinical Decision Support Systems (CDSS) are considered to be the most feasible tool for adopting pharmacogenomic testing into clinical routine.<br><br>Objective: To discuss important factors for implementing pharmacogenomic CDSS into German hospitals.<br><br>Methods: We analyzed two relevant studies. Furthermore, we interviewed data privacy officers of three German university hospitals and examined relevant legal regulations in literature.<br><br>Results: There are three major barriers for implementing pharmacogenomic CDSS into German hospitals: (i) the legal uncertainty; (ii) the lack of machine-readable data; (iii) the remaining knowledge gap of both genetics and pharmacogenomics among physicians.<br><br>Conclusion: The implementation of passive clinical decision support (CDS) for somatic mutations in the form of structured pharmacogenomic reports might be the most feasible CDS feature for clinicians in German hospitals