Current electronic health records (EHRs) have a long way to go to meet the challenges of genetic/genomic medicine, reports a study in the July issue of Genetics in Medicine, the official peer-reviewed journal of The American College of Medical Genetics.
The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
Although EHR systems have the potential to help integrate genetic information into everyday health care, they’ll need new structure, standardization, and functionality to meet this goal, according to the new study led by Dr. Maren Scheuner of RAND Corporation, Santa Monica, Calif. The researchers interviewed medical geneticists, genetic counselors, primary care doctors, and EHR vendors and specialists regarding the present and future role of EHRs in storing and using genetic information.
Ability to Handle Genetic Information Is Low, but So Is Demand—So Far
State-of-the-art EHRs lack the features needed even to record genetic information in a systematic way—much less use it in medical decision making, the responses indicated. While current EHR systems provide space for information on the patient’s family history, there were limitations on how the information could be entered and used. For example, few systems were able to create or store a pedigree charting the inheritance of genetic conditions within families. The EHRs provided little clinical decision support to help doctors assess the risk of genetic diseases or provide treatment alerts based on the family history. Systems also varied in the way they handled the security of genetic test results.
Three-fourths of the health care providers interviewed felt that current EHR systems did not meet their needs for genetic/genomic medicine. At the same time, most perceived little to no demand for such capabilities from health care providers. The EHR vendors supported this view—when it came to genetic content, they felt their customers wanted "just the basics."
Most participants thought that genetic/genomic medicine had yet to have much impact on health information technology and EHRs. However, many felt that genetic information would significantly affect patient care within the next decade, including such areas as risk assessment and management, disease prevention, and personalized medical care. They also thought that EHRs had the potential to affect the delivery of genetic/genomic medicine—for example, in managing genetic information, aiding medical decision-making, the use of genetic services, and promoting genetic research.
Electronic health records are expected to play an increasingly important role in medical care in the years ahead. Experts believe that EHRs could play an important role in helping to move genetic information into clinical practice—including educating health care providers about the proper use of genetic data in medical decision making.
"However, basic requirements must be addressed by EHR products before they can effectively facilitate adoption of genetic/genomic information," Dr. Scheuner and co-authors conclude. The study helps identify key areas for improvement of EHRs in recording and displaying family history, documenting and organizing genetic tests and results, providing support for doctors’ decision making, and addressing the privacy and security of genetic information.
"The emergence of genetics into medicine’s mainstream presents great challenges, not the least of which is the management of huge amounts of information," comments Dr. James P. Evans, Editor-in-Chief of Genetics in Medicine. "The EHR, if properly implemented, could allow us to harness the power of genetics in patient care, but the sheer amount of data generated by such techniques as array analysis and extensive sequencing will require innovations in data handling and presentation. Moreover, even depicting family history in a useful way has proven difficult in the context of electronic records. This article in GIM points out important challenges and how to address them as we move together as a nation towards less fragmented and more useful medical records."
Source: American College of Medical Genetics
