The Integrated, Individualized, and Intelligent Prescribing (I3P) Network performed a multi-site test of the hypothesis that integrating genetic information within electronic medical records (EMRs) in diverse healthcare environments is not only achievable but also can alter physician behavior toward a vision of personalized medicine.

Principal Investigators

Joshua C. Denny M.D., M.S.
Vanderbilt University
Director, Center for Precision Medicine
Associate Professor of Biomedical Informatics and Medicine
Department of Biomedical Informatics

Mia Levy M.D., Ph.D.
Vanderbilt University
Director, Cancer Clinical Informatics Vanderbilt-Ingram Cancer Center
Ingram Assistant Professor of Cancer Research
Assistant Professor of Biomedical Informatics and Medicine

Project Description

For decades, Vanderbilt University Medical Center (VUMC) has been at the forefront of pharmacogenomic discovery and its translation into clinical practice. In 2010, VUMC launched both the Pharmacogenomic Resource for Enhanced Decisions in Care and Treatment (PREDICT) and the Personalized Cancer Medicine Initiative (PCMI) to empower providers and patients with the genetic information and electronic medical record tools to facilitate genetically-informed clinical decision-making at the point of care.

With the Integrated, Individualized, Intelligent Prescribing (I3P) Network, VUMC implemented, disseminated, and evaluated pharmacogenetic-based prescribing for germline variants and in cancer. I3P starts with two efforts in place at VUMC. In 2010, VUMC launched both PREDICT and PCMI to empower providers and patients with the genetic information and electronic medical record tools to facilitate genetically-informed clinical decision-making at the point of care. In I3P, VUMC collaborated with four diverse adopter sites – the Nashville Veterans Affairs Medical Center, Nashville General Hospital at Meharry Medical College, Sanford Heath Care, and Aurora Health Care – to disseminate the tools developed for PREDICT and PCMI to tailor therapy based on germline and somatic gene variants of known clinical significance. These sites employ different EMR and e-prescribing systems and include diverse patient populations.

Project Goals

  • To develop, maintain, and disseminate genome-informed clinical decision support within Adopter Sites.
  • To select and prospectively genotype patients within Adopter Sites for subsequent genotype-tailored therapy.
  • To evaluate the impact of integrating genetic data and clinical decision support into Adopter Site EMRs.

Collaborating Sites

Nashville Veterans Affairs Medical Center and the Middle Tennessee Research Institute 
The Nashville Veterans Affairs Medical Center (NVAMC) offers primary, secondary, and tertiary care to over 250,000 veterans predominantly in middle Tennessee. NVAMC utilizes the Veterans Health Administration’s nationally deployed electronic medical record, the Computerized Patient Record System (CPRS). The Middle Tennessee Research Institute of NVAMC is dedicated to state-of-the-art innovation in healthcare informatics for use in research, performance measurement, clinical care, and quality improvement. Dr. Michael Matheny leads the implementation efforts at NVAMC.

Nashville General Hospital at Meharry Medical College 
Nashville General Hospital at Meharry Medical College is a Historically Black College with a mission to improve the health and health care of minorities and the underserved. The principal site for clinical training is Nashville General Hospital at Meharry, representing a unique public-private alliance between Meharry and the Nashville Hospital Authority. Nashville General Hospital utilizes different EMR systems in its inpatient and outpatient settings, offering a unique opportunity for intra-institutional integration. Dr. John Murray leads the implementation efforts at Meharry Medical College.

Sanford Health Care
Sanford Health Care is a large multi-specialty group practice located in the north Midwestern United States. Its geographical footprint covers five states: Montana, North Dakota, South Dakota, Minnesota, Iowa and Nebraska. There are over 2 million patients and 1,000 physicians in the Sanford Health Care network, and all clinical specialties are represented

Aurora Health Care
Aurora Health Care is a not-for-profit integrated health care organization headquartered in Milwaukee, Wisconsin, that encompasses 15 hospitals, 172 outpatient clinics, and 82 pharmacies. Since 2010, AHC hospitals and clinics have used Epic as their EMR, encompassing 4.7 million unique patients in a highly diverse population. AHC maintains the largest volume of cardiovascular procedures in Wisconsin and sees nearly 7,000 new cancer patients each year. Dr. Michael Michalkiewicz leads the implementation efforts at Aurora Healthcare.