We thank Drs. Frye and Nemeroff for their perspective on the promising role of pharmacogenetics (PGx) in the selection of antidepressant treatment [1]. In their article, Frye and Nemeroff discuss several challenges to the wide-scale application of PGx for the treatment of depression. We agree that there are several challenges to address, particularly regarding electronic health record (EHR) integration, in order for PGx to become a widely utilized resource for antidepressant selection and dosing.

EHR functionality is required for PGx implementation to succeed, including readily accessible, discrete results and integrated clinical decision support (CDS). PGx laboratory results are shared in several ways with patients and providers: as paper reports which are subsequently scanned into the EHR and/or manually entered into a patient’s chart; as electronic files uploaded into the media section of the EHR; in patient or provider-facing websites independent of the EHR; or as laboratory results directly transmitted via HL7 messaging. Returning results and providing CDS in static formats, such as electronic files, do not allow for the interpretation or prescribing recommendations to change as PGx knowledge evolves. For example, the 2023 Clinical Pharmacogenetics Implementation Consortium (CPIC) serotonin reuptake inhibitor guidelines provide actionable recommendations for sertraline based on CYP2B6 metabolizer status, whereas previous CPIC serotonin reuptake inhibitor guidelines did not [2, 3]. CDS returned in electronic file formats prior to 2023 would not contain CYP2B6/sertraline recommendations, therefore not reflecting current consensus. To ensure accurate and high-quality patient care, CDS must be revised periodically and dynamically changed as evidence and treatment recommendations are updated.

我们感谢博士。 Frye 和 Nemeroff 对药物遗传学 (PGx) 在抗抑郁治疗选择中的前景广阔的看法 [1]。 Frye 和 Nemeroff 在他们的文章中讨论了大规模应用 PGx 治疗抑郁症面临的几个挑战。我们同意，为了使 PGx 成为抗抑郁药物选择和剂量的广泛使用的资源，有几个挑战需要解决，特别是在电子健康记录 (EHR) 集成方面。

PGx 成功实施需要 EHR 功能，包括易于访问的离散结果和集成临床决策支持 (CDS)。 PGx 实验室结果以多种方式与患者和提供者共享：作为纸质报告，随后扫描到 EHR 中和/或手动输入到患者图表中；作为上传到 EHR 媒体部分的电子文件；在独立于 EHR 的面向患者或提供者的网站中；或作为实验室结果通过 HL7 消息直接传输。返回结果并以静态格式（例如电子文件）提供 CDS 不允许解释或处方建议随着 PGx 知识的发展而改变。例如，2023 年临床药物遗传学实施联盟 (CPIC) 血清素再摄取抑制剂指南根据 CYP2B6 代谢状态提供舍曲林的可行建议，而之前的 CPIC 血清素再摄取抑制剂指南则没有提供 [2, 3]。 2023 年之前以电子文件格式返回的 CDS 不包含 CYP2B6/舍曲林建议，因此不反映当前共识。为了确保准确和高质量的患者护理，CDS 必须定期修订，并随着证据和治疗建议的更新而动态变化。