title: Pragmatic and Ethical Challenges of Incorporating the Genome into the Electronic Medical Record.
abstract: Recent successes in the use of gene sequencing for patient care highlight the potential of genomic medicine. For genomics to become a part of usual care, pertinent elements of a patient's genomic test must be communicated to the most appropriate care providers. Electronic medical records may serve as a useful tool for storing and disseminating genomic data. Yet, the structure of existing EMRs and the nature of genomic data pose a number of pragmatic and ethical challenges in their integration. Through a review of the recent genome-EMR integration literature, we explore concrete examples of these challenges, categorized under four key questions: What data will we store? How will we store it? How will we use it? How will we protect it? We conclude that genome-EMR integration requires a rigorous, multi-faceted and interdisciplinary approach of study. Problems facing the field are numerous, but few are intractable.
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Nishimura
authors.affiliation: Department of Biomedical Informatics and Medical Education, University of Washington ; Department of Pediatrics, University of Washington ; Department of Computer Science and Engineering, University of Washington.
authors.forename: Peter
authors.initials: P
authors.lastname: Tarczy-Hornoch
authors.affiliation: Department of Laboratory Medicine, University of Washington.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Shirts
keywords: Computerized Prescriber Order Entry; Genomic medicine; clinical decision support; clinical genomics; clinical informatics; electronic medical records; genotype; implementation science; individualized medicine; personalized medicine; pharmacogenetics; pharmacogenomics; translational research