EHRs Aren't Ready For Genomics-Driven Healthcare

Electronic health records need ancillary systems that incorporate individuals' genetics into clinical decision support decisions, experts say.
 7 Big Data Solutions Try To Reshape Healthcare
7 Big Data Solutions Try To Reshape Healthcare
(click image for larger view and for slideshow)
Current electronic health record (EHR) systems are not designed to work with genomic data, but could be modified to incorporate genomic clinical decision support (CDS) coming out of ancillary systems, says a viewpoint article in the Journal of the American Medical Association (JAMA). This approach, the authors argue, could enable doctors to benefit from the latest genomic advances without waiting for EHR vendors to catch up with this scientific revolution. But eventually, they add, EHRs will have to change.

In "Crossing the Omic Chasm: A Time for Omic Ancillary Systems," the three authors -- Justin Starren, MD, PhD; Marc S. Williams, MD; and Erwin P. Bottinger, MD -- cite a recent Institute of Medicine report noting that storage of genomic, epigenomic, proteomic and metabolomic data (the "omics") is not feasible in the current generation of EHRs. EHRs are designed to display only clinically relevant information, they point out. That's why radiological images are typically stored in picture archiving and communication systems (PACS), and only the radiology report is sent to the EHR.

While a medical image typically represents nearly 300 times as much data as the report based on it, whole-genome sequencing of a particular individual requires 5 to 10 GB of storage, 50 times more than an image. So an ancillary system is required to store that amount of data, the article says.

In addition, the authors observe, EHRs do not include the analytics needed to interpret genetic variations in light of the latest scientific research. And the genetic data will have to be stored for a long time, they point out, to reanalyze and reinterpret the genomic results in the context of evolving knowledge.

[ Genetics-based CDS will be routine five years from now, experts say. Learn more about Health IT In 2018: Crystal Ball Predictions. ]

The authors predict that large organizations will likely operate their own omics ancillary systems. Small practices will probably use reference labs, which will add omics ancillary services to their current service lines.

The article offers three ways that decision support based on genomic analysis could inform medical decision making: