title: The business of genomic testing: a survey of early adopters.
abstract: OBJECTIVE
  The practice of "genomic" (or "personalized") medicine requires the availability of appropriate diagnostic testing. Our study objective was to identify the reasons for health systems to bring next-generation sequencing into their clinical laboratories and to understand the process by which such decisions were made. Such information may be of value to other health systems seeking to provide next-generation sequencing testing to their patient populations.
  
  
  METHODS
  A standardized open-ended interview was conducted with the laboratory medical directors and/or department of pathology chairs of 13 different academic institutions in 10 different states.
  
  
  RESULTS
  Genomic testing for cancer dominated the institutional decision making, with three primary reasons: more effective delivery of cancer care, the perceived need for institutional leadership in the field of genomics, and the premise that genomics will eventually be cost-effective. Barriers to implementation included implementation cost; the time and effort needed to maintain this newer testing; challenges in interpreting genetic variants; establishing the bioinformatics infrastructure; and curating data from medical, ethical, and legal standpoints. Ultimate success depended on alignment with institutional strengths and priorities and working closely with institutional clinical programs.
  
  
  CONCLUSIONS
  These early adopters uniformly viewed genomic analysis as an imperative for developing their expertise in the implementation and practice of genomic medicine.
authors.affiliation: Hofstra North Shore-LIJ School of Medicine, Uniondale, New York, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Crawford
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Bry
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: John
authors.initials: J
authors.lastname: Pfeifer
authors.affiliation: Mawd Pathology Group, North Kansas City, Missouri, USA.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Caughron
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Black-Schaffer
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kant
authors.affiliation: College of American Pathologists, Northfield, Illinois, USA.
authors.forename: Jill H
authors.initials: JH
authors.lastname: Kaufman
mesh_terms: D003657:Decision Making; D004059:Diffusion of Innovation; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005820:Genetic Testing / Q000191:economics / Q000379:methods*; D005823:Genetics / Q000639:trends; D023281:Genomics; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis*; D057285:Precision Medicine / Q000379:methods; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D014481:United States