Are electronic health records ready for genomic medicine?
OBJECTIVE
The goal of this project was to assess genetic/genomic content in electronic health records.


METHODS
Semistructured interviews were conducted with key informants. Questions addressed documentation, organization, display, decision support and security of family history and genetic test information, and challenges and opportunities relating to integrating genetic/genomics content in electronic health records.


RESULTS
There were 56 participants: 10 electronic health record specialists, 18 primary care clinicians, 16 medical geneticists, and 12 genetic counselors. Few clinicians felt their electronic record met their current genetic/genomic medicine needs. Barriers to integration were mostly related to problems with family history data collection, documentation, and organization. Lack of demand for genetics content and privacy concerns were also mentioned as challenges. Data elements and functionality requirements that clinicians see include: pedigree drawing; clinical decision support for familial risk assessment and genetic testing indications; a patient portal for patient-entered data; and standards for data elements, terminology, structure, interoperability, and clinical decision support rules. Although most said that there is little impact of genetics/genomics on electronic records today, many stated genetics/genomics would be a driver of content in the next 5-10 years.


CONCLUSIONS
Electronic health records have the potential to enable clinical integration of genetic/genomic medicine and improve delivery of personalized health care; however, structured and standardized data elements and functionality requirements are needed.
Scheuner
Maren T
MT
RAND Corporation, Santa Monica, California 90407-2138, USA. Scheuner@rand.org
de Vries
Han
H
Kim
Benjamin
B
Meili
Robin C
RC
Olmstead
Sarah H
SH
Teleki
Stephanie
S
D001291:Attitude of Health Personnel; D030661:Genetic Privacy / Q000592:standards*; D005826:Genetics, Medical / Q000379:methods*; D007407:Interviews as Topic; D016347:Medical Records Systems, Computerized / Q000458:organization & administration* / Q000592:standards* / Q000639:trends; D012015:Reference Standards