Integration of genomic data in Electronic Health Records--opportunities and dilemmas.
OBJECTIVE
In this paper we give an overview about the challenge the postgenomic era poses on biomedical informaticists. The occurrence of new (genomic) data types necessitates new data models, new viewing metaphors and methods to deal with the disclosure of genomic data. We discuss integration issues when inferring phenotype and genotype data. Another challenge is to find the right phenotype to genotype data in order to get appropriate case numbers for sound clinical genotype-phenotype inference studies.


METHODS
Genomic data could be integrated in an Electronic Health Record (EHR) in several ways. We describe patient-centered and pointer-based integration strategies and the corresponding data types and data models. The inference mechanisms for the interpretation of row data contain different agents. We describe vertical, horizontal and temporal agents.


RESULTS
We have to deal with several new data types, not being standardized for EHR integration. Genomic data tends to be more structured than phenotype data. Beyond the development of new data models, vertical, horizontal and temporal agents have to be developed in order to link genotype and phenotype. As the genomic EHR will contain very sensitive data, confidentiality and privacy concerns have to be addressed.


CONCLUSIONS
Given the necessity to capture both environment and genomic state of a patient and their interaction, clinical information systems have to be redesigned. While genotyping seems to be automatable easily, this is not the case for clinical information. More integration work on terminologies and ontologies has to be done.
Sax
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Children's Hospital Informatics Program, Harvard-MIT Division of Health Sciences and Technology, Children's Hospital Boston, Massachusetts, USA. usax@med.uni-goettingen.de
Schmidt
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D019295:Computational Biology; D016494:Computer Security; D003219:Confidentiality; D003628:Database Management Systems; D030541:Databases, Genetic; D005240:Feasibility Studies; D015894:Genome, Human; D005838:Genotype; D006751:Hospital Information Systems; D006801:Humans; D016347:Medical Records Systems, Computerized; D010641:Phenotype; D018511:Systems Integration