  OBJECTIVE: To better understand clinician needs and preferences for the
display of pharmacogenomic (PGx) information in clinical decision support (CDS)
tools.
  MATERIALS AND METHODS: We developed a semi-structured interview to collect
feedback and preferences in six key areas of PGx CDS design, from clinicians
who had prior experience with live PGx CDS tools. Eight clinicians from
Northwestern Medicine's (NM) General Internal Medicine clinic participated in
the study.
  RESULTS: Clinicians expressed preference for interruptive pop-up alerts
during order entry, brief descriptions of relevant drug-gene interactions, and
a clear and specific recommended alternative course of action when a medication
is contraindicated. They did not wish to see detailed genetic data, preferring
phenotypic information predicted from the genotype. Nor did they wish to be
interrupted when genetic test results do not indicate a change in treatment
plan. Clinicians reported little familiarity with Clinical Pharmacogenetic
Implementation Consortium prescribing recommendations but reported trusting
recommendations of their professional societies and resources like UpToDate.
Analysis of unstructured comments concurred with structured results, indicating
a general uncertainty among participants around how to interpret and apply PGx
information in practice.
  DISCUSSION: Results point to several underlying principles that can inform
future PGx CDS alert designs: Be Specific and Actionable; Be Brief; Display
Phenotypes not Genotypes; Rely on Sources Clinicians Already Trust; and, Be
Adaptable to Learning Effects.
  CONCLUSION: This study is part of a broader socio-technical design approach
to PGx CDS design underway at NM and provides a baseline for future PGx CDS
development. Designs based on these results have the potential to improve
clinician education and adherence levels, and to improve patient outcomes.
