Fundamentals of Drug Metabolism and Pharmacogenomics Within a Learning Healthcare System Workflow Perspective

This chapter introduces fundamental concepts of pharmacogenomics, including drug metabolism, and provides an informatics workflow-based perspective inspired by a learning healthcare system framework. Our intent is that the reader sees pharmacogenomics as a foundation of precision medicine, which is reliant upon informatics to deliver actionable patient-tailored knowledge at the point of care. Further, pharmacogenomics knowledge is poised to be further developed so as to be amenable to multi-drug comorbid disease treatment necessitated by precision medicine practice. Upon reviewing this chapter, we hope the reader understands how informatics is uniquely suited to i) enhance clinic-based precision medicine practice through appropriate dissemination of patient-tailored actionable pharmacogenomics knowledge, and ii) to advance the knowledge base underpinning pharmacogenomics by gleaning insights from real world outcomes of these same clinic-based populations. The methodologic considerations highlighted within this workflow-base perspective encompass end-to-end forward and reverse translational informatics activities, designed to both appropriately deploy existing pharmacogenomics knowledge, as well as contribute to its advancement by harnessing insights from real-world data.