Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network

Abstract Background To realize potential public health benefits from genetic and genomic innovations, understanding how best to implement the innovations into clinical care is important. The objective of this study was to synthesize data on challenges identified by six diverse projects that are part...

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Main Authors: Nina R. Sperber, Janet S. Carpenter, Larisa H. Cavallari, Laura J. Damschroder, Rhonda M. Cooper-DeHoff, Joshua C. Denny, Geoffrey S. Ginsburg, Yue Guan, Carol R. Horowitz, Kenneth D. Levy, Mia A. Levy, Ebony B. Madden, Michael E. Matheny, Toni I. Pollin, Victoria M. Pratt, Marc Rosenman, Corrine I. Voils, Kristen W. Weitzel, Russell A. Wilke, R. Ryanne Wu, Lori A. Orlando
Format: Article
Language:English
Published: BMC 2017-05-01
Series:BMC Medical Genomics
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12920-017-0273-2
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language English
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author Nina R. Sperber
Janet S. Carpenter
Larisa H. Cavallari
Laura J. Damschroder
Rhonda M. Cooper-DeHoff
Joshua C. Denny
Geoffrey S. Ginsburg
Yue Guan
Carol R. Horowitz
Kenneth D. Levy
Mia A. Levy
Ebony B. Madden
Michael E. Matheny
Toni I. Pollin
Victoria M. Pratt
Marc Rosenman
Corrine I. Voils
Kristen W. Weitzel
Russell A. Wilke
R. Ryanne Wu
Lori A. Orlando
spellingShingle Nina R. Sperber
Janet S. Carpenter
Larisa H. Cavallari
Laura J. Damschroder
Rhonda M. Cooper-DeHoff
Joshua C. Denny
Geoffrey S. Ginsburg
Yue Guan
Carol R. Horowitz
Kenneth D. Levy
Mia A. Levy
Ebony B. Madden
Michael E. Matheny
Toni I. Pollin
Victoria M. Pratt
Marc Rosenman
Corrine I. Voils
Kristen W. Weitzel
Russell A. Wilke
R. Ryanne Wu
Lori A. Orlando
Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network
BMC Medical Genomics
Precision medicine
Pharmacogenomics
Electronic health record
Patient engagement
Provider engagement
Implementation
author_facet Nina R. Sperber
Janet S. Carpenter
Larisa H. Cavallari
Laura J. Damschroder
Rhonda M. Cooper-DeHoff
Joshua C. Denny
Geoffrey S. Ginsburg
Yue Guan
Carol R. Horowitz
Kenneth D. Levy
Mia A. Levy
Ebony B. Madden
Michael E. Matheny
Toni I. Pollin
Victoria M. Pratt
Marc Rosenman
Corrine I. Voils
Kristen W. Weitzel
Russell A. Wilke
R. Ryanne Wu
Lori A. Orlando
author_sort Nina R. Sperber
title Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network
title_short Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network
title_full Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network
title_fullStr Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network
title_full_unstemmed Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network
title_sort challenges and strategies for implementing genomic services in diverse settings: experiences from the implementing genomics in practice (ignite) network
publisher BMC
series BMC Medical Genomics
issn 1755-8794
publishDate 2017-05-01
description Abstract Background To realize potential public health benefits from genetic and genomic innovations, understanding how best to implement the innovations into clinical care is important. The objective of this study was to synthesize data on challenges identified by six diverse projects that are part of a National Human Genome Research Institute (NHGRI)-funded network focused on implementing genomics into practice and strategies to overcome these challenges. Methods We used a multiple-case study approach with each project considered as a case and qualitative methods to elicit and describe themes related to implementation challenges and strategies. We describe challenges and strategies in an implementation framework and typology to enable consistent definitions and cross-case comparisons. Strategies were linked to challenges based on expert review and shared themes. Results Three challenges were identified by all six projects, and strategies to address these challenges varied across the projects. One common challenge was to increase the relative priority of integrating genomics within the health system electronic health record (EHR). Four projects used data warehousing techniques to accomplish the integration. The second common challenge was to strengthen clinicians’ knowledge and beliefs about genomic medicine. To overcome this challenge, all projects developed educational materials and conducted meetings and outreach focused on genomic education for clinicians. The third challenge was engaging patients in the genomic medicine projects. Strategies to overcome this challenge included use of mass media to spread the word, actively involving patients in implementation (e.g., a patient advisory board), and preparing patients to be active participants in their healthcare decisions. Conclusions This is the first collaborative evaluation focusing on the description of genomic medicine innovations implemented in multiple real-world clinical settings. Findings suggest that strategies to facilitate integration of genomic data within existing EHRs and educate stakeholders about the value of genomic services are considered important for effective implementation. Future work could build on these findings to evaluate which strategies are optimal under what conditions. This information will be useful for guiding translation of discoveries to clinical care, which, in turn, can provide data to inform continual improvement of genomic innovations and their applications.
topic Precision medicine
Pharmacogenomics
Electronic health record
Patient engagement
Provider engagement
Implementation
url http://link.springer.com/article/10.1186/s12920-017-0273-2
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spelling doaj-77a2bcd782f4437289687c75498f494e2021-04-02T05:15:11ZengBMCBMC Medical Genomics1755-87942017-05-0110111110.1186/s12920-017-0273-2Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) networkNina R. Sperber0Janet S. Carpenter1Larisa H. Cavallari2Laura J. Damschroder3Rhonda M. Cooper-DeHoff4Joshua C. Denny5Geoffrey S. Ginsburg6Yue Guan7Carol R. Horowitz8Kenneth D. Levy9Mia A. Levy10Ebony B. Madden11Michael E. Matheny12Toni I. Pollin13Victoria M. Pratt14Marc Rosenman15Corrine I. Voils16Kristen W. Weitzel17Russell A. Wilke18R. Ryanne Wu19Lori A. Orlando20Division of General Internal Medicine, Duke University School of MedicineIndiana University School of NursingDepartment of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of FloridaImplementation Pathways, LLC and VA Ann Arbor Center for Clinical Management ResearchUniversity of Florida, College of Pharmacy and Medicine and Center for PharmacogenomicsVanderbilt University Medical CenterDuke Center for Applied Genomics & Precision Medicine, Duke UniversityUniversity of Maryland School of MedicineIcahn School of Medicine at Mount SinaiIndiana University School of NursingVanderbilt University Medical CenterNational Human Genome Research Institute (NHGRI)Vanderbilt University Medical Center, Tennessee Valley HealthCare System VAUniversity of Maryland School of MedicineIndiana University School of NursingIndiana University School of NursingWilliam S. Middleton Memorial Veterans HospitalUniversity of Florida, College of Pharmacy and Medicine and Center for PharmacogenomicsSanford School of Medicine, University of South DakotaDuke Center for Applied Genomics & Precision Medicine, Duke UniversityDuke Center for Applied Genomics & Precision Medicine, Duke UniversityAbstract Background To realize potential public health benefits from genetic and genomic innovations, understanding how best to implement the innovations into clinical care is important. The objective of this study was to synthesize data on challenges identified by six diverse projects that are part of a National Human Genome Research Institute (NHGRI)-funded network focused on implementing genomics into practice and strategies to overcome these challenges. Methods We used a multiple-case study approach with each project considered as a case and qualitative methods to elicit and describe themes related to implementation challenges and strategies. We describe challenges and strategies in an implementation framework and typology to enable consistent definitions and cross-case comparisons. Strategies were linked to challenges based on expert review and shared themes. Results Three challenges were identified by all six projects, and strategies to address these challenges varied across the projects. One common challenge was to increase the relative priority of integrating genomics within the health system electronic health record (EHR). Four projects used data warehousing techniques to accomplish the integration. The second common challenge was to strengthen clinicians’ knowledge and beliefs about genomic medicine. To overcome this challenge, all projects developed educational materials and conducted meetings and outreach focused on genomic education for clinicians. The third challenge was engaging patients in the genomic medicine projects. Strategies to overcome this challenge included use of mass media to spread the word, actively involving patients in implementation (e.g., a patient advisory board), and preparing patients to be active participants in their healthcare decisions. Conclusions This is the first collaborative evaluation focusing on the description of genomic medicine innovations implemented in multiple real-world clinical settings. Findings suggest that strategies to facilitate integration of genomic data within existing EHRs and educate stakeholders about the value of genomic services are considered important for effective implementation. Future work could build on these findings to evaluate which strategies are optimal under what conditions. This information will be useful for guiding translation of discoveries to clinical care, which, in turn, can provide data to inform continual improvement of genomic innovations and their applications.http://link.springer.com/article/10.1186/s12920-017-0273-2Precision medicinePharmacogenomicsElectronic health recordPatient engagementProvider engagementImplementation