A survey of informatics approaches to whole-exome and whole-genome clinical reporting in the electronic health record.
OBJECTIVE
Genome-scale clinical sequencing is being adopted more broadly in medical practice. The National Institutes of Health developed the Clinical Sequencing Exploratory Research (CSER) program to guide implementation and dissemination of best practices for the integration of sequencing into clinical care. This study describes and compares the state of the art of incorporating whole-exome and whole-genome sequencing results into the electronic health record, including approaches to decision support across the six current CSER sites.


METHODS
The CSER Medical Record Working Group collaboratively developed and completed an in-depth survey to assess the communication of genome-scale data into the electronic health record. We summarized commonalities and divergent approaches.


RESULTS
Despite common sequencing platform (Illumina) adoptions, there is a great diversity of approaches to annotation tools and workflow, as well as to report generation. At all sites, reports are human-readable structured documents available as passive decision support in the electronic health record. Active decision support is in early implementation at two sites.


CONCLUSIONS
The parallel efforts across CSER sites in the creation of systems for report generation and integration of reports into the electronic health record, as well as the lack of standardized approaches to interfacing with variant databases to create active clinical decision support, create opportunities for cross-site and vendor collaborations.
1] National Institutes of Health National Human Genome Research Institute Clinical Sequencing Exploratory Research Electronic Medical Records Working Group, Bethesda, Maryland, USA [2] University of Washington, Seattle, Washington, USA.
Peter
P
Tarczy-Hornoch
Laura
L
Amendola
Samuel J
SJ
Aronson
Levi
L
Garraway
Stacy
S
Gray
Robert W
RW
Grundmeier
Lucia A
LA
Hindorff
Gail
G
Jarvik
Dean
D
Karavite
Matthew
M
Lebo
Sharon E
SE
Plon
Eliezer
E
Van Allen
Karen E
KE
Weck
Peter S
PS
White
Yaping
Y
Yang
D020000:Decision Support Systems, Clinical / Q000592:standards; D057286:Electronic Health Records / Q000592:standards*; D059472:Exome; D015894:Genome, Human; D006306:Health Surveys; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D008490:Medical Informatics; D009316:National Institutes of Health (U.S.); D017421:Sequence Analysis; D014481:United States; D057188:Workflow