The Sanford Imagenetics team developing pharmacogenetics recently collaborated to write textbook chapters looking at how to translate genomic medicine into clinical practice.
Pharmacogenomics (PGx) is the study of how genetics or genes influence how your body processes certain drugs and may help identify a drug that your body cannot process as expected.
Sanford Health, a national leader in integrating genetic testing into patient care, has contributed in three different chapters to “Clinical Decision Support for Precision Genetic Medicine: Foundations and Implementation,” a 296-page book that examines how to translate genomic medicine into clinical practice. . .
The Sanford authors agreed that it was not an easy process, but it was worthwhile. 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 programmes.
Benefits of an integrated health system
“We are very fortunate here at Sanford that we do everything from start to finish,” said Joel van Heukelom, PharmD, MBA, Imagenetics Pharmacy Supervisor. “We have our own in-house lab so the patient can draw their blood here and they go to the lab and then they come to us and we help translate it to the end user doctor. It’s all in a closed space, so we have a good understanding of what it takes. Most institutions probably don’t have that.”
The impetus for contributing to the book was rooted in the authors’ work in pharmacogenomics with Sanford Health. They have a story to tell that includes this science and its potential benefits. This story can be told in the language most appropriate to fellow healthcare professionals, as was the case with the textbook, or to potential patients who might benefit from what remains a relatively new tool in medicine. Either way, it is the patient who wins in the end.
“Depending on a person’s genes, some medications may not be effective for them,” explained Debbie Figueroa, PhD, ABMGG, director of the Medical Genetics Laboratory. They may be prescribed medications that do not help them at all. This is why pharmacogenomics is important. It allows us, before the prescriber gives the drug to the 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 regarding dosage as well.”
Writing the book on PGx
Sanford’s team’s contributions spanned many areas in the world of pharmacogenomics and accompanied the work of other writers who represented some of the nation’s best healthcare systems. Specifically, the Sanford team worked on the following chapters:
- Michelle Erickson-Johnson, PhD, MB/HCLD, Senior Director of Health at Sanford, Laboratory Operations and Enterprise Quality, and Dr. Figueroa assisted in compiling Chapter Three of the book titled: Laboratory Considerations for Pharmaceutical Genomics Testing.
- April Schultz, PharmD, Director of Imagenetics Operations and Pharmaceutical Genetic Services; Amanda Massman, PharmD, Imagenetics Clinical Pharmacotherapeutic Pharmacist; Dr. Van Heukelom and Dr. Van Heukelom contributed to Chapter 8, “Clinical Considerations in Support of Clinical Decision Support for Precision Medicine”.
- Masman, Schultz, and Van Heuchelum also contributed to Chapter 12, “Infrastructure Integration for Clinical Decision Support and Translation into Real-world Applications”.
In each chapter, collaboration and communication were vital in producing a cohesive end product. This was necessary in the paragraph by paragraph sense, but also in the general flow of the book.
“We got together as a team and decided who would work on what,” said Dr. Erickson Johnson. “We cut it out and worked on it independently for a while, then we’ll get back together and make sure we’re all on the same track and writing for the same purpose and for the same reasons.”
How did the book develop?
The project began when Dr. Schultz was approached by the book’s editors (Drs. Beth Devine, Richard Boyce, and Christine Weisanen) about the possibility of contributing with Sanford Pharmacists to a chapter on the laboratory’s role in providing pharmacological-based care.
“As a pharmacist, I said no to lab experience, but I told them I knew some people who might be interested in working in our lab,” said Dr. Schultz, referring to the experts at the Sanford Molecular Genetics Laboratory. “And then I told them that our pharmacy team also has a broad knowledge base when it comes to clinical decision support cutting and how to apply it.”
In the end, after conversations about the book’s overall content, the editors gave the Sanford authors the freedom to decide what they wanted to contribute to the book. This led to the creation of three topics, including a final chapter that summarizes what a pharmacogenetics test might look like from a patient’s perspective.
“We really needed to keep remembering the audience we were speaking to,” said Dr. Erickson-Johnson. “You get so far inside your head sometimes from a writing standpoint, you have to ask yourself, ‘Now would that make sense to someone who doesn’t work in the lab? “
The authors regularly reviewed the work of their colleagues to ensure that their prose was available to healthcare professionals outside the realm of pharmacogenomics. It was part of the process, as they agreed to improve the quality of the final product.
To this end, in Chapter 12, the team created a model patient and then followed that patient through different scenarios.
“We’ve shown how to make use of the information in the rest of the book,” Dr. Schultz said. “We’ve gone from the time your blood is taken in the lab to the time the results are in the doctor’s hands.”
Sanford really cares
Putting together the chapters was difficult but ultimately rewarding. Several authors joked about how, in the days after finishing writing, they decided to avoid similar projects in the future. Since then they have appreciated the achievement.
“During the process, it was like, ‘We’ll never do this again,’” Dr. Masman said with a laugh. “But now that we’re on the road, when we look at the final product, we’re talking about all the different people we’ve worked with and how much we all learned.”
One of the things they were happy to learn was the national interest in the medical profession for the work Sanford Imagenetics does. Asking to be a part of the book in itself was a huge compliment. Fulfilling them was the reward.
“The Imagenetics Genetic Medicine initiative shows that Sanford truly cares about the well-being of its patients,” said Dr. Van Heuchelom. “Sanford is willing to invest in this to allow us to take better care of the people who treat within our walls. We are investing in better outcomes.”