{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:47:03Z","timestamp":1782107223295,"version":"3.54.5"},"reference-count":9,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Translational Sci"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The implementation of novel precision medicine tools in pediatric medicine requires buy\u2010in from multiple interest groups and a shift from traditional medical paradigms. In an effort to implement a precision drug\u2010dosing project for an anti\u2010coagulant drug in the neonatal intensive care unit (NICU) at a large children's hospital, a multi\u2010specialty team made up of clinicians, scientists, private industry, and technology specialists formed and worked collaboratively over multiple years. Despite best efforts, the project's success was hindered by multiple foreseen and unforeseen barriers. Through the telling of a specific case example, these barriers and the key considerations for mitigating them are discussed to give future teams better knowledge and preparation abilities. The themes discussed are encompassed by \u201cpeople,\u201d \u201cprocess,\u201d and \u201ctechnology.\u201d The integration of precision dosing tools into hospital systems (such as electronic health records [EHR]) demands careful coordination across clinicians, pharmacists, nurses, and hospital information technology (IT) teams. Informaticians play a key role in safely embedding innovations into clinical practice. Ethics boards face challenges evaluating novel technologies like AI\/ML. Comprehensive representation on ethics boards is essential for effective oversight of new digital tools. Technical integration of third\u2010party applications into EHRs is complex, especially across international borders. Differences in measurement units, coding systems, and test environments can cause deployment issues. Privacy assessments, secure data access protocols, and data residency and compliance are critical. Finally, sustaining precision medicine innovations requires institutional investment beyond initial research funding. Success hinges on attention to people, process, and technology.<\/jats:p>","DOI":"10.1111\/cts.70646","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:43:19Z","timestamp":1781858599000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Science Outpaces Infrastructure: People, Process, and Technology Challenges for Precision Dosing in Children"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2137-8339","authenticated-orcid":false,"given":"Tamorah","family":"Lewis","sequence":"first","affiliation":[{"name":"Division of Clinical Pharmacology &amp; Toxicology The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"Department of Paediatrics University of Toronto Temerty Faculty of Medicine  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7582-8422","authenticated-orcid":false,"given":"Karim","family":"Jessa","sequence":"additional","affiliation":[{"name":"Department of Paediatrics University of Toronto Temerty Faculty of Medicine  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6433-1154","authenticated-orcid":false,"given":"Vijay","family":"Ivaturi","sequence":"additional","affiliation":[{"name":"Pumas\u2010AI, Inc  Dover Delaware USA"},{"name":"Center for Pharmacometrics, Manipal Academy of Higher Education  Manipal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Noack","sequence":"additional","affiliation":[{"name":"Pumas\u2010AI, Inc  Dover Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9247-0530","authenticated-orcid":false,"given":"Dilum P.","family":"Aluthge","sequence":"additional","affiliation":[{"name":"Pumas\u2010AI, Inc  Dover Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9282-053X","authenticated-orcid":false,"given":"David","family":"M\u00fcller\u2010Widmann","sequence":"additional","affiliation":[{"name":"Pumas\u2010AI, Inc  Dover Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Capello","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Information Management &amp; Technology, Project Management Office  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Fong","sequence":"additional","affiliation":[{"name":"Epic Application Special Team, Department of Information Services The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1711-8676","authenticated-orcid":false,"given":"Ashleigh","family":"Miatello","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Services, the Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2478-604X","authenticated-orcid":false,"given":"Melanie","family":"Barwick","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Services, the Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2023.106958"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2021.106515"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10040347"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/pix109"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00075\u201018"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2020.00551"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265\u2010025\u201002152\u20106"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addr.2024.115421"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2021.08.075"}],"container-title":["Clinical and Translational Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cts.70646","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cts.70646","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cts.70646","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:52:16Z","timestamp":1782103936000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/10.1111\/cts.70646"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":9,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/cts.70646"],"URL":"https:\/\/doi.org\/10.1111\/cts.70646","archive":["Portico"],"relation":{},"ISSN":["1752-8054","1752-8062"],"issn-type":[{"value":"1752-8054","type":"print"},{"value":"1752-8062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-02-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70646"}}