Electronic medical records and personalized medicine

Hoffman, Mark A.; Williams, Marc S.

doi:10.1007/s00439-011-0992-y

Cited by 50 publications

(34 citation statements)

References 25 publications

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“…The system should have enough capacity to record large datasets and interface with legacy systems (in real time or through import functions) to capture historical laboratory data, with the goal of storing lifelong results on each patient. Capabilities for handling large genomic data sets, while providing meaningful reports and ''justin-time'' education to clinical providers, 45 will be increasingly necessary in future LIS. 2.…”

Section: Administrative and Financial Issuesmentioning

confidence: 99%

The Ideal Laboratory Information System

Sepulveda

Young

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Laboratory information systems (LIS) are critical components of the operation of clinical laboratories. However, the functionalities of LIS have lagged significantly behind the capacities of current hardware and software technologies, while the complexity of the information produced by clinical laboratories has been increasing over time and will soon undergo rapid expansion with the use of new, high-throughput and high-dimensionality laboratory tests. In the broadest sense, LIS are essential to manage the flow of information between health care providers, patients, and laboratories and should be designed to optimize not only laboratory operations but also personalized clinical care.Objective.-To list suggestions for designing LIS with the goal of optimizing the operation of clinical laboratories while improving clinical care by intelligent management of laboratory information.Data Sources.-Literature review, interviews with laboratory users, and personal experience and opinion.Conclusions.-Laboratory information systems can improve laboratory operations and improve patient care. S ince the 1970s, laboratory information systems (LIS) have been critical components of the operation of clinical laboratories. They were initially developed to collect, record, present, organize, and archive laboratory results, often with a focus on generating information for proper financial management of the laboratory. While information technology in general is advancing at an increasingly faster rate, particularly in the hardware domain but also in software development, LIS have not evolved correspondingly. For example, the current LIS make very limited use of artificial intelligence approaches such as neural 1 or Bayesian 2 networks, fuzzy logic, 3 genetic algorithms, 4 and artificial immune recognition systems.5 Health care systems in general can be characterized as conservative and resistant to change and current health care information systems (HIS) and LIS are a reflection of this conservative approach. Despite the potential benefits in cost-efficiency and patient care improvements possible with well-designed HIS/LIS, most of these systems lag significantly behind the possibilities afforded by current information technology. In fact, some of these systems have deficiencies that most homeand Web-based software have long overcome, such as efficient navigation, rapid response, and spelling correction.Modern clinical laboratories are purveyors of information, in the form of laboratory results, which may be numbers, text, graphs, or other images, together with interpretative data, to assist health care providers in delivering optimal patient care. The complexity of the information produced by clinical laboratories has been increasing over time, and with the advent of large-scale analytic techniques, such as microarrays and next-generation sequencing, the amount of data produced will rapidly grow by several orders of magnitude. Advanced developments in data management and bioinformatics will need to be incorporated into LIS ...

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Section: Administrative and Financial Issuesmentioning

confidence: 99%

The Ideal Laboratory Information System

Sepulveda

Young

2013

Archives of Pathology &Amp; Laboratory Medicine

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“…McMullan [2] indicates that health care professionals respond to patients with such internet-acquired expertise in one or more ways, including feeling threatened by the information and responding defensively, by collaborating with the patient and forming a patient-centered relationship, or by helping to guide the patient to the most reliable health information. One possible solution to foster the second and third scenarios above in the context of genomic medicine is to utilize the power of a fully functional electronic health record system (EHR) [345]. The capabilities provided by such EHRs, particularly through clinical decision support (CDS) systems, have been demonstrated to significantly improve certain care processes, although the evidence of impact on health outcomes such as morbidity or mortality is less robust [6].…”

Section: Contextmentioning

confidence: 99%

Generation and Implementation of a Patient-Centered and Patient-Facing Genomic Test Report in the EHR

Goehringer¹,

Bonhag²,

Jones³

et al. 2018

eGEMs

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Context:Communication of genetic laboratory results to patients and providers is impeded by the complexity of results and reports. This can lead to misinterpretation of results, causing inappropriate care. Patients often do not receive a copy of the report leading to possible miscommunication. To address these problems, we conducted patient-centered research to inform design of interpretive reports. Here we describe the development and deployment of a specific patient-centered clinical decision support (CDS) tool, a multi-use patient-centered genomic test report (PGR) that interfaces with an electronic health record (EHR).Implementation Process:A PGR with a companion provider report was configured for implementation within the EHR using locally developed software (COMPASS™) to manage secure data exchange and access.Findings:We conducted semi-structured interviews with patients, family members, and clinicians that showed they sought clear information addressing findings, family implications, resources, prognosis and next steps relative to the genomic result. Providers requested access to applicable, available clinical guidelines. Initial results indicated patients and providers found the PGR contained helpful, valuable information and would provide a basis for result-related conversation between patients, providers and family.Major Themes:Direct patient involvement in the design and development of a PGR identified format and presentation preferences, and delivery of relevant information to patients and providers, prompting the creation of a CDS tool.Conclusions:Research and development of patient-centered CDS tools designed to support improved patient outcomes, are enhanced by early and substantial engagement of patients in contributing to all phases of tool design and development.

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“…Tools such as point-of-care computerized decision support are beginning to be developed and hold promise for directing physicians to the information they need precisely when they need it. 10 Credentialing requirements for ordering sophisticated tests such as genome sequencing could be powerful incentives for education, though at the cost of restricting use. Inclusion of genomic information in specialty board examinations and maintenance of certification testing may provide another unique and powerful motivator for physician education; indeed, given their many other certification requirements, inclusion in specialty boards is likely a must for genomics to get any attention at all.…”

Section: Challenges and Barriers To Physician Genomics Educationmentioning

confidence: 99%