JMIR Publications

ABSTRACT

Background:

Allopurinol carries a risk of severe cutaneous adverse reactions among patients with the HLA-B58:01 allele, yet uptake of guideline-recommended testing remains low in clinical practice.

Objective:

To develop, implement, and evaluate a national, electronic health record (EHR)-based dashboard to promote HLA-B58:01 testing among allopurinol users at risk for severe cutaneous adverse reactions within the Veterans Health Administration (VHA).

Methods:

This observational study used structured laboratory and prescribing data from the VHA Corporate Data Warehouse to identify allopurinol users across 56 VA facilities between October 2022 and April 2024. The dashboard was built in Microsoft PowerBI and deployed nationally in April 2023. We applied a two-group interrupted time series (ITS) design to evaluate the association between facility-level dashboard engagement and completion of HLA-B58:01 testing among Veterans prescribed allopurinol who self-identified as Asian or African American. Facilities were categorized as high or low engagement based on the proportion of post-launch weeks with at least one recorded dashboard session (≥20% vs. <20%). Weekly testing completion rates were calculated for each facility using structured lab result fields. Dashboard use was measured through PowerBI activity logs. Facilities were excluded if they participated in pilot testing, used the Cerner EHR, lacked structured test result fields, or had no recorded dashboard sessions.

Results:

The study included 56 facilities, of which one third were identified as high engagement facilities. A total of 294 unique individuals had accessed the dashboard at least once during the study period across all facilities. The median (IQR) number of allopurinol users at baseline was 312 (115 - 625). By week 80, the overall rate increased to 3.3% from 1.8%, with greater improvements at high-engagement facilities (from 3.4% to 5.7%) than at low-engagement facilities (from 1.2% to 2.4%). In ITS analysis, the weekly post-intervention increase in testing was significantly higher at high-engagement sites compared to low-engagement sites (0.032 vs. 0.004 percentage points/week; between-group difference 0.027 percentage points/week; p = 0.03).

Conclusions:

National implementation of an EHR-based dashboard was associated with increased HLA-B58:01 testing among allopurinol users in high-risk racial groups, although overall testing remained infrequent. Greater engagement with the dashboard was linked to more substantial gains, highlighting the potential of scalable health IT tools to improve medication safety and address pharmacogenomic disparities across integrated healthcare systems. Although testing rose modestly after rollout, overall rates remained low, indicating that further strategies are required to align testing practices with guidelines.