Approach 1: Generic BPA + CDS Hooks

Scenario: Order-select CDS hook provides patient/medication context to Helix; Generic BPA displays patient-specific pharmacogenomics recommendations

CDS Hooks Workflow: Order-Select Integration
1
👨‍⚕ī¸ Clinician
Selects medication in Epic
e.g., Clopidogrel 75mg
↓
2
đŸĨ Epic
Fires order-select CDS hook
Patient ID, Medication, Context
↓
3
đŸ§Ŧ Helix
Receives context, queries patient genetic data, evaluates drug-gene interaction
CYP2C19: *2/*2 (Poor Metabolizer)
↓
4
đŸ§Ŧ Helix
Returns BPA card with patient-specific recommendation
⚠ī¸ High Risk + Alternative Suggestions
↓
5
đŸĨ Epic
Displays Generic BPA alert with Helix recommendations
BPA Card (see below)

✅ Integration Benefit: Order-select CDS hook provides real-time patient/medication context to Helix. Helix returns a BPA card containing patient results, matched CPIC guideline, and alternative medication suggestions.

BPA Examples

Two scenarios showing how the Generic BPA works in different clinical situations:

Scenario 1: High-Risk Drug-Gene Interaction Detected

⚠ī¸ Pharmacogenetic Risk Detected

Alert triggered because: Helix detected HIGH risk for current medication order based on patient genetic data.

BPA card returned by Helix via CDS Hooks:
Gene: CYP2C19
Phenotype: Poor Metabolizer (*2/*2)
Current Order: Clopidogrel 75mg
Risk Level: HIGH
CPIC Guideline: Level A

Recommendation: Consider alternative P2Y12 inhibitor (prasugrel or ticagrelor). Clopidogrel requires CYP2C19 activation and may be ineffective in Poor Metabolizers.

📖 CPIC Guideline: Clopidogrel and CYP2C19

📋 Pharmacy Team Coordination: For complex interactions, this approach can include pharmacy team alerts. BPA can notify provider when pharmacy team has been notified, enabling coordinated medication decision-making.

ℹī¸

Scenario 2: Patient Eligible for PGx Reuse Test

Alert triggered because: Patient is already sequenced by Helix and eligible for a rapid PGx test for the ordered medication.

BPA card returned by Helix via CDS Hooks:
Patient Status: Previously Sequenced by Helix
Current Order: Clopidogrel 75mg
Test Available: PGx Clopidogrel Reuse Test
Expected Turnaround Time: 5 minutes
CPIC Guideline: Level A

This patient has been previously sequenced by Helix. A Helix PGx Clopidogrel reuse can be placed without need of a sample collection to determine CYP2C19 status for clopidogrel. Results will be ready approximately 5 minutes after the order is placed.

📖 CPIC Guideline: Clopidogrel and CYP2C19

❌ Traditional BPA Approach

  • 50+ separate BPA rules
  • Each drug-gene pair hardcoded
  • Update = Epic IT tickets for each BPA
  • High maintenance burden
  • High Epic IT effort

✅ Generic BPA + CDS Hooks

  • ONE Generic BPA rule
  • CDS hook provides context to Helix
  • Update logic in Helix (no Epic IT tickets)
  • Low Epic maintenance burden
  • Moderate Epic IT effort
🟡 Epic IT Burden: MODERATE

đŸ’Ŧ Discussion Questions for CMO

Key Insight

This approach balances proactive alerts with manageable Epic IT effort. CDS Hooks provides real-time patient/medication context to Helix, which returns BPA cards with patient-specific recommendations. Epic IT burden is dramatically reduced: 98% fewer BPAs to maintain. Pharmacogenomics logic updates happen in Helix without Epic IT tickets. This is the recommended starting point for most health systems implementing pharmacogenomics programs.