Genomics-Enabled Learning Health Care Systems Gathering and Using Genomic Information to Improve Patient Care and Research: Workshop Summary (2015) / Chapter Skim
Currently Skimming:
4 Genomics and the EHR in a Learning Health Care System
4 Genomics and the EHR in a Learning Health Care System
Pages 37-46
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 37... ...
Still, even once those data standards have been established, additional challenges to a genomics-enabled EHR will remain, including deciding how and what information will be shared, ensuring equity of access to the information, developing useful clinical decision support and providing clinicians with the knowledge to use it, and providing insurance coverage for genetic tests that have been demonstrated to have clinical value.
|
From page 38... ...
The disparate approaches, lack of standardization, and limited sharing of approaches all present barriers to developing a scalable genomicsenabled learning health care system. "People can learn best practices from work that others have done," Moss said, "but at a technical level there's no sharing of what's been done to make it easier, especially for the non-academic medical centers that are trying to do this." Moss pointed to three areas in particular in which changes need to be made in order to make learning health systems a reality.
|
From page 39... ...
CREATING A SUPPORTIVE INFRASTRUCTURE A learning health system aligns science and informatics, develops strong patient–clinician partnerships, provides incentives for innovation, and creates a culture of continuous improvement to produce the best care at the lowest cost, said Steve Leffler, the chief medical officer at The University of Vermont Medical Center and a professor of surgery at the University of Vermont College of Medicine. Each of these actions, in the context of genomic medicine, can be used with EHRs to advance health care.
|
From page 40... ...
We are interviewing the patient and the physician about this experience, and maybe there was some valid reason, but I'm concerned that there wasn't." Health care providers need training to be able to do phenotyping, to see the benefits of genomic information to patients, and to use the information in clinics, said Fowler. "There is a real dearth of skills in this particular area, and for us that's a particular challenge." There are several barriers to the integration of genomics into the EHR, Leffler said.
|
From page 41... ...
Though ICD-11 promises to improve the situation, the current systems are problematic -- a point that was reiterated by several other presenters. EHRs need to make it easy for health care providers to do the right thing and hard to make errors, Leffler said.
|
From page 42... ...
Peterson said that health care providers do not always follow the advice provided by clinical decision support, and the reason is often that they have additional information about a patient that factors into their decisions. "We would like our rates of following advice to probably go a little higher than they are," he said, "but it's never going to be 100 percent and probably shouldn't be." The information generated by not following program advice goes back into the EHR, and this information could be used to do comparative effectiveness studies of the value of advice.
|
From page 43... ...
The Regional Health Information Network in Jinzhou, China, is another example of an organization that is successfully managing big data. 2 The challenges of analyzing hundreds of thousands of genomes, http://www.broad institute.org/~carneiro/talks/20140612-qatar_genomics_conference.pdf (accessed February 25, 2015)
|
From page 44... ...
Because of the significant amount of time allocated to consenting patients for testing and then interpreting and explaining the results, covering the costs would make it possible for genetic testing to be implemented in a practical way. The policies of insurers are an obstacle to genomic medicine, Jarvik said.
|
From page 45... ...
Peterson made the case for sharing knowledge resources among institutions. In particular, the sharing of knowledge resources is very helpful to programs that are just getting started with performing genomic medicine, including phenotyping algorithms, variant calling, determining the clinical interpretation of variants, and maintaining a rule repository for clinical decision support.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.