CC BY-NC-ND 4.0 · Appl Clin Inform 2024; 15(02): 378-387
DOI: 10.1055/a-2274-6763
Research Article

PillHarmonics: An Orchestrated Pharmacogenetics Medication Clinical Decision Support Service

Robert H. Dolin
1   Elimu Informatics, El Cerrito, California, United States
Edna Shenvi
1   Elimu Informatics, El Cerrito, California, United States
Carla Alvarez
1   Elimu Informatics, El Cerrito, California, United States
Randolph C. Barrows Jr.
1   Elimu Informatics, El Cerrito, California, United States
Aziz Boxwala
1   Elimu Informatics, El Cerrito, California, United States
Benson Lee
2   College of Pharmacy, Touro University California, Vallejo, California, United States
Brian H. Nathanson
3   OptiStatim, LLC, Longmeadow, Massachusetts, United States
Yelena Kleyner
1   Elimu Informatics, El Cerrito, California, United States
Rachel Hagemann
4   Independent Contractor, San Francisco, California, United States
Tonya Hongsermeier
1   Elimu Informatics, El Cerrito, California, United States
Joan Kapusnik-Uner
5   First Databank, San Francisco, California, United States
Adnan Lakdawala
1   Elimu Informatics, El Cerrito, California, United States
James Shalaby
1   Elimu Informatics, El Cerrito, California, United States
› Author Affiliations
Funding U.S. Department of Health and Human Services. National Institutes of Health. National Human Genome Research Institute. NHGRI 1R43HG011832-01A1: PillHarmonics: An Orches.


Objectives Pharmacogenetics (PGx) is increasingly important in individualizing therapeutic management plans, but is often implemented apart from other types of medication clinical decision support (CDS). The lack of integration of PGx into existing CDS may result in incomplete interaction information, which may pose patient safety concerns. We sought to develop a cloud-based orchestrated medication CDS service that integrates PGx with a broad set of drug screening alerts and evaluate it through a clinician utility study.

Methods We developed the PillHarmonics service for implementation per the CDS Hooks protocol, algorithmically integrating a wide range of drug interaction knowledge using cloud-based screening services from First Databank (drug–drug/allergy/condition), PharmGKB (drug–gene), and locally curated content (drug–renal/hepatic/race). We performed a user study, presenting 13 clinicians and pharmacists with a prototype of the system's usage in synthetic patient scenarios. We collected feedback via a standard questionnaire and structured interview.

Results Clinician assessment of PillHarmonics via the Technology Acceptance Model questionnaire shows significant evidence of perceived utility. Thematic analysis of structured interviews revealed that aggregated knowledge, concise actionable summaries, and information accessibility were highly valued, and that clinicians would use the service in their practice.

Conclusion Medication safety and optimizing efficacy of therapy regimens remain significant issues. A comprehensive medication CDS system that leverages patient clinical and genomic data to perform a wide range of interaction checking and presents a concise and holistic view of medication knowledge back to the clinician is feasible and perceived as highly valuable for more informed decision-making. Such a system can potentially address many of the challenges identified with current medication-related CDS.

Protection of Human and Animal Subjects

The study protocol was reviewed by Advarra Institutional Review Board and deemed IRB exempt, not requiring monitoring by an IRB.

Supplementary Material

Publication History

Received: 24 October 2023

Accepted: 07 February 2024

Accepted Manuscript online:
22 February 2024

Article published online:
16 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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