The Use of Precision Medicine to Support the Precision of Clinical Decisions in care delivery

Abstract

Objectives: Objective: Precision medicine uses individualized patient data, including genomic and social determinants of health SDoH), to provide optimized personalized patient treatment. In this scoping review, we summarize studies published in the last two years that reported on implementation of precision medicine in clinical decision support (CDS) related to precision medicine. Methods: We searched PubMed for manuscripts published in 2022 and 2023 to retrieve publications that included CDS and precision medicine keywords and Mesh terms. We reviewed the abstracts and full texts to apply the inclusion criteria that the study must have described the implementation of precision medicine related CDS within electronic health records. We extracted the domain, type of data used in CDS, target population included in the implementation from the final set of included manuscripts. Results: Our search retrieved 285 manuscripts and papers. Sixteen (16) papers met inclusion criteria after manual review of the full text. Eight of the reviewed papers studied the successful implementation of pharmacogenomics in CDS, four studies investigated the implementation of disease risk, and only one paper described the implementation of CDS integrating social determinants of health. Conclusion: Our scoping review of recent literature highlighted several findings. Pharmacogenomics is the most implemented precision medicine intervention based on published studies. Few reports describing disease risk and polygenic risk scores were found and no study addressed CDS for continuous biometric mon-itoring. Despite the increasing attention to social determinants of health as a key predictor of health outcomes, only one CDS incorporating SDoH have been publicly reported. Regular updates to scoping reviews can investigate barriers to implementation and identify solutions.