Michael Icardi, MD, VA national director of pathology and laboratory medicine and chairman of the VA’s Molecular Genetics Pathology Workgroup, agreed. “For pharmacogenetic data to be useful, healthcare systems need to capture results of laboratory testing as machine readable data of sufficient detail that it can be returned to patients and incorporated into the electronic health record data, clinical decision support tools and pharmacy informatics systems.”
The VA has started to tackle the challenge of capturing and using genetic data. “If results of PGx tests are available for the Level A drugs, the results should be considered to guide therapy,” Chanfreau-Coffinier said. “VA Pathology, Pharmacy, and Genomic Medicine Services are collaborating to integrate veterans’ pharmacogenetic information in the electronic health record. This is an essential step to generate an evidence base for evaluating drug/gene interactions and guide which pharmacogenetic tests should be performed by VA labs.”
Pharmacogenetic data gathered by the VA could have a significant impact beyond veterans.
“Understanding pharmacogenetics across a racially diverse population is a priority of ours,” said Rachel Ramoni, chief research and development officer in the VA’s Office of Research and Development. “Minority populations have been underrepresented in most genetic studies. The VA’s contribution to pharmacogenetics research is particularly important because our veterans come from racially diverse backgrounds. What is learned from these studies will help us improve the health of the veteran population, while generating information that can be translated to the overall U.S. population.”
While the details remain to be worked out, the direction of the VA in terms of pharmacogenetic testing is clear.
“We’re still in the infancy or adolescent phase for all this,” said David Oslin, MD, director the VISN 4 Mental Illness Research, Education, and Clinical Center, leader of the PRIME Care initiative, and associate chief of staff for Behavioral Health at the Corporal Michael J. Crescenz VAMC in Philadelphia. “I can see in five to 10 years, assuming PGx testing continues to show benefit or shows greater benefit, we’ll do more testing. We’re just getting this area of medicine ramped up in a lot of ways.”
Chanfreau-Coffinier C, Hull LE, Lynch JA, DuVall SL, Damrauer SM, Cunningham FE, Voight BF, Matheny ME, Oslin DW, Icardi MS, Tuteja S. Projected Prevalence of Actionable Pharmacogenetic Variants and Level A Drugs Prescribed Among US Veterans Health Administration Pharmacy Users. JAMA Netw Open. 2019 Jun 5;2(6):e195345.