Emerging landscape of genomics in the electronic health record for personalized medicine

The Information Technology (IT) roadmap for personalized medicine requires Electronic Health Records (EHRs), extension of Healthcare IT (HIT) standards, and understanding of how genetics/genomics should be integrated into the clinical applications. For reduced overall costs and development times, these three initiatives should run in parallel. EHRs must contain structured data and infrastructure that enables quality analysis, Clinical Decision Support (CDS) and messaging within the healthcare information network. Fortunately, as a result of sustained financial commitment to nongenetic‐based healthcare, the industry has HIT data standards and understanding of EHR functionality that improves patient safety and outcomes while reducing overall healthcare costs. However, the HIT standards and EHR functional requirements, needed for personalized medicine, are only beginning to support simple genetic tests and need significant extension. In addition, our understanding of the clinical implications of genomic data is evolving and translation of new discovery into clinical care remains a challenge. Therefore, priority areas include CDS, educational resources, and knowledgebases for the EHR, clinical and research data warehouses, messaging frameworks, and continued review of healthcare policies and regulations supporting personalized medicine. Where core infrastructure remains to be developed and implemented, funding is needed for pilot projects, data standards, policy, and stakeholder collaboration. Hum Mutat 32:1–5, 2011. © 2011 Wiley‐Liss, Inc.

[1]  W. H. Inmon,et al.  Building the data warehouse , 1992 .

[2]  Stephen R. Gardner Building the data warehouse , 1998, CACM.

[3]  J. Stoker,et al.  The Department of Health and Human Services. , 1999, Home healthcare nurse.

[4]  Henry C. Chueh,et al.  A security architecture for query tools used to access large biomedical databases , 2002, AMIA.

[5]  David W. Bates,et al.  Design and implementation of a comprehensive outpatient Results Manager , 2003, J. Biomed. Informatics.

[6]  Nhs Confederation Our inheritance, our future: realising the potential of genetics in the NHS (DOH White Paper) , 2003 .

[7]  C. Lynch,et al.  Improved survival of follicular lymphoma patients in the surveillance, epidemiology, and end-results (SEER) program , 2004 .

[8]  P. Kwok,et al.  Human Variome Project: an international collaboration to catalogue human genetic variation. , 2006, Pharmacogenomics.

[9]  Henry C. Chueh,et al.  Calculating the Benefits of a Research Patient Data Repository , 2006, AMIA.

[10]  Alexander Turchin,et al.  The Quality Data Warehouse: Delivering Answers on Demand , 2006, AMIA.

[11]  Qi Li,et al.  Report Central: Quality Reporting Tool in an Electronic Health Record , 2006, AMIA.

[12]  Guilherme Del Fiol,et al.  Integrating Genetic Information Resources with an EHR , 2006, AMIA.

[13]  M. Gulley,et al.  Clinical laboratory reports in molecular pathology. , 2007, Archives of pathology & laboratory medicine.

[14]  Blackford Middleton,et al.  Sharing Electronic Laboratory Results in a Patient Portal - a Feasibility Pilot , 2007, MedInfo.

[15]  M. A. Hoffman,et al.  The genome-enabled electronic medical record , 2007, J. Biomed. Informatics.

[16]  John Glaser,et al.  White Paper: Advancing Personalized Health Care through Health Information Technology: An Update from the American Health Information Community's Personalized Health Care Workgroup , 2008, J. Am. Medical Informatics Assoc..

[17]  Sowmya R. Rao,et al.  Electronic health records in ambulatory care--a national survey of physicians. , 2008, The New England journal of medicine.

[18]  Adrian H. Zai,et al.  Designing healthcare information technology to catalyse change in clinical care. , 2008, Informatics in primary care.

[19]  T. Ferris,et al.  Options for slowing the growth of health care costs. , 2008, The New England journal of medicine.

[20]  T. Čufer Which tools can I use in daily clinical practice to improve tailoring of treatment for breast cancer? The 2007 St Gallen guidelines and/or Adjuvant! Online. , 2008, Annals of oncology : official journal of the European Society for Medical Oncology.

[21]  J. Belmont,et al.  The futility of genomic counseling: essential role of electronic health records , 2009, Genome Medicine.

[22]  Barbara L. Smith,et al.  The impact of primary tumor size, lymph node status, and other prognostic factors on the risk of cancer death , 2009, Cancer.

[23]  Eugene Clark,et al.  Implications of Genomics for Clinical Informatics , 2009, Encyclopedia of Database Systems.

[24]  P. Sethi,et al.  Translational bioinformatics and healthcare informatics: computational and ethical challenges. , 2009, Perspectives in health information management.

[25]  J. Teague,et al.  Somatic mutation databases as tools for molecular epidemiology and molecular pathology of cancer: Proposed guidelines for improving data collection, distribution, and integration , 2009, Human mutation.

[26]  Jerome A. Osheroff,et al.  Bmc Medical Informatics and Decision Making Information Management to Enable Personalized Medicine: Stakeholder Roles in Building Clinical Decision Support , 2009 .

[27]  Bruce E Bray,et al.  Efficiency of CYP2C9 Genetic Test Representation for Automated Pharmacogenetic Decision Support , 2009, Methods of Information in Medicine.

[28]  J. Pestian,et al.  Personalizing Drug Selection Using Advanced Clinical Decision Support , 2009, Biomedical informatics insights.

[29]  Gudmundur A. Thorisson,et al.  Genotype–phenotype databases: challenges and solutions for the post-genomic era , 2009, Nature Reviews Genetics.

[30]  J. Kalus Health information technology--results from a roundtable discussion. , 2009 .

[31]  S. J. Lewis,et al.  Health Information Technology—Results From a Roundtable Discussion , 2009, Journal of Managed Care Pharmacy : JMCP.

[32]  George P Patrinos,et al.  Locus‐specific database domain and data content analysis: evolution and content maturation toward clinical use a , 2010, Human mutation.

[33]  D. Blumenthal,et al.  The "meaningful use" regulation for electronic health records. , 2010, The New England journal of medicine.

[34]  Jennifer L Hafterson,et al.  Feasibility Study for Collection of HER2 Data by National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program Central Cancer Registries , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[35]  Lisa Webster,et al.  Health information technology: A new world for pharmacy. , 2010, Journal of the American Pharmacists Association : JAPhA.

[36]  C. G. Donald,et al.  The Genetic Information Nondiscrimination Act of 2008 , 2011 .