Pilot Implementation of Clinical Genomic Data into the Native Electronic Health Record: Challenges of Scalability

Abstract

Abstract Background Recently, electronic health record (EHR) vendors have allowed for the storage of discrete genomic data within the EHR. With this new capability there remain many challenges related to adoption and implementation. Geisinger has genomic data available for approximately 145,000 patients. With the goal of integrating genetic data into the EHR for the entire sequenced population, we performed a pilot study on a subpopulation to assess the plausibility of large-scale deployment. Objectives Import genetic results into the EHR for seven pharmacogenes, Center for Disease Control tier one conditions, and hereditary hemochromatosis. Build decision support and information resources for each condition. Identify barriers to scaling the deployment. Identify short-term and long-term solutions to overcome identified barriers. Methods Discrete genomic variants were imported into the EHR. Maintenance guidelines and information resources were developed for each genetic condition and best practice alerts were built for pharmacogenomic variants. Weekly calls were held to address barriers to implementation. A list of challenges was maintained throughout the process. Solutions were proposed and categorized into short-term and long-term solutions. Results Challenges were identified and solutions proposed for five discrete areas: Transmitting data from the laboratory to the EHR. Maintenance of information and decision support. Disparate implementation needs of geneticists versus primary care. Differing perceptions/uses of discrete genomic data versus a PDF report. Classification and reclassification of variants. Conclusion Scaling the use of genomic data in the EHR requires the engagement of hospitals, open standards communities, laboratories, EHR vendors, and genomic information resources.