Epic Integration Options - Helix Pharmacogenomics

Executive Summary

Decision: How should Helix pharmacogenomic decision support integrate with Epic?

Core Tradeoff: More Epic integration = better proactive alerts BUT higher IT burden and longer timeline.

Recommendation: Start with Approach 1 (Generic BPA + CDS Hooks), evolve to Approach 2 (Pharmacist Alerts) as adoption grows.

Why start with Approach 1, not Approach 3 (iFrame)?

iFrame is passive — clinicians must seek it out. Approach 1 delivers proactive order-time alerts; no action needed from the provider to benefit.
Alert fatigue concern? That's what Approach 2 solves. Pharmacist triage filters alerts before they reach providers — the right answer to fatigue is smarter alerts, not no alerts.
iFrame is a supplement, not a foundation. Add it in Phase 3 to cover edge cases once proactive alerts are live and proven.

3 Integration Options (Recommended path: Approach 1 → Approach 2)

#	Approach	Epic IT Burden	Proactive Alerts	Key Tradeoff	View
1	Generic BPA + CDS Hooks START HERE Epic stores genetic data; 1 smart BPA	MODERATE	Yes (order-time)	Epic-native data + alerts. Only 1 BPA (not 50+). Still interrupts provider workflow at order time.	View →
2	Pharmacist Alerts PHASE 2 TARGET Background monitoring + pharmacist triage	MODERATE	Yes (background)	Phase 2 target: Proactive alerts via pharmacist (reduces provider burden).	View →
3	iFrame Embedded PHASE 3 OPTIONAL Epic tab shows full Helix portal	LOW	No (passive only)	Embedded in Epic but no alerts. Clinician must click "Pharmacogenomics" tab to see risk.	Mockup → Live Demo →

🚀 Recommended: Phased Implementation Strategy

Start fast, prove value, then add sophistication. This approach minimizes risk and accelerates time-to-value.

PHASE 1: Launch

Approach 1: Generic BPA + CDS Hooks

Moderate Epic IT setup effort
Proactive order-time alerts
Only 1 BPA to maintain (not 50+)
Prove value with pilot users

Goal: Launch with proactive alerts using manageable Epic IT effort

PHASE 2: Scale

Approach 2: Pharmacist Alerts

Add background monitoring
Add pharmacist triage workflow
Reduce provider alert fatigue
Moderate Epic IT effort (In Basket setup)

Goal: Maximize clinical impact with pharmacist-filtered proactive alerts

PHASE 3: Optimize (Optional)

Add Approach 3: iFrame Embed

Embedded portal access
Low Epic IT effort
Passive lookup for edge cases
Only if needed

Goal: Provide passive lookup option for edge cases not covered by proactive alerts

Why This Phased Approach Works:

✓ Start Proactive

Begin with order-time alerts (Approach 1). Immediate clinical safety impact.

✓ Manageable Effort

Moderate IT effort to launch with only 1 BPA to maintain (not 50+).

✓ Prove Before Scaling

Phase 1 proves value. Add pharmacist triage (Phase 2) only if adoption is strong.

✓ Reduce Alert Fatigue

Phase 2 pharmacist filtering means providers only see high-value alerts.

Benefits of Starting with Approach 1, Then Evolving to Approach 2

Proactive Safety First: Launch with order-time alerts (Approach 1) - immediate clinical impact, not passive lookup
Manageable IT Effort: Only 1 BPA to maintain (not 50+), balances proactive alerts with reasonable Epic burden
Natural Progression: Start with order-time alerts (Approach 1) → Add pharmacist triage (Approach 2) to reduce alert fatigue
Build Internal Champions: Early clinical wins create advocates who support Phase 2 investment
Reduced Alert Fatigue: Once scaled, pharmacist triage (Phase 2) filters alerts so providers only contacted for actionable cases
Proven Model: Phase 2 approach (Pharmacist Alerts) used by successful PGx programs (ActX, Mayo Clinic, Vanderbilt)
Scalable Staffing: Phase 2 requires dedicated pharmacist support - predictable and linear scaling
Flexible: Can add passive lookup (Approach 3) later with low IT effort if needed for edge cases

Decision Framework for Your Organization

If your priority is...	Then choose...
Proactive alerts with manageable Epic IT effort	Phase 1: Approach 1 (Generic BPA + CDS Hooks)
Proactive safety without provider alert fatigue	Phase 2: Approach 2 (Pharmacist Alerts with triage)
Passive lookup for edge cases	Phase 3: Approach 3 (iFrame Embed - optional passive access)
Limited Epic IT resources available right now	Start planning Approach 1 — Approach 3 alone delivers no proactive alerts and cannot replace Approach 1's clinical safety value
Want proactive alerts with growth path to reduce alert fatigue	Phased Approach (Approach 1 → Approach 2 progression)

Next Steps

Review mockups with CMIO, Pharmacy Lead, and Epic Analyst
Confirm phased approach (Approach 1 → Approach 2 progression)
Epic IT configures Generic BPA + CDS Hooks for Phase 1 launch
Pilot with early adopter clinicians, gather feedback
If pilot successful, begin Phase 2 planning (pharmacist triage workflow)
Full Phase 2 rollout (Pharmacist Alerts with background monitoring)

Epic Integration Options for Helix Pharmacogenomics