Like many clinicians, Jess Calohan, a behavioral health nurse practitioner and a teacher of pharmacology at George Washington University in Sterling, Va., works diligently to select what he believes is the best possible prescription for a patient.
But because the prescribing process traditionally has been based on trial and error, he often finds out afterward that the medication was not effective, and then he begins looking for a different medicine to prescribe.
Then, Calohan learned that DrFirst, a medication management vendor, offers its Rcopia electronic prescribing platform with pharmacogenomics decision support that assesses how a patient’s genes affect their response to drugs. This enables a physician to order a genomic test and then use the decision support to determine how a patient’s genetic makeup may affect the therapeutic efficiency of the medication being considered.
For example, Calohan was treating a patient in her mid-20s with depression who was on multiple medications and who was referred by a primary care physician who had run out of options. Calohan got somewhat better results from a drug regimen, but they were not optimal.
Calohan prescribed a genomic test for the depressed patient, although some other providers thought she was not adhering to the medication regimen. “After I ordered the genomic test, the results showed this patient was a rapid metabolizer and could not absorb the drugs previously prescribed appropriately,” he recalls. “I prescribed a medication from a different class, and the patient’s symptoms improved dramatically. Within three months, she was in complete remission of the depression.”
The genetic test uses a swab to get a sample from the inside cheek; it can be done in a physician’s office or at the patient’s home, and it is then sent to a lab for analysis. Results are automatically returned via Rcopia to the clinician’s electronic health record and to the patient, and results also can be forwarded to other providers.
The Rcopia prescribing software integrates into the workflow of more than 300 electronic medical record products, so clinicians avoid having to toggle between the prescribing and EHR systems, according to Calohan.
In addition to Calohan’s use of Rcopia in his behavioral health practice, other early adopter clients include cardiology, pain medicine and primary care specialists, according to the vendor.
There are some challenges, particularly the $500 to $700 cost of tests, which Medicare and Medicaid pay but some third-party insurers do not, Calohan notes. Working with Rcopia, he came up with a list of how various insurers cover costs and added the coverage list into the EHR to help patients make financial decisions.
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