Table 1 Comparison of CDS, Return of Results and Educational Strategies for IGNITE Projects
From: The IGNITE network: a model for genomic medicine implementation and research
Site/Project | Characteristics of CDS | Return of results | Educational strategies |
|---|---|---|---|
Duke University: Implementation, Adoption and Utility of Family History in Diverse Care Settings | • Open source (OpenCDS) • Bidirectional • Based on HL7 Virtual Medical Record standard • Epic-based system | • Directly to patients and providers via CDS within the EHR | • English and Spanish language versions of FHH software • Printed and web based materials • Patient workbook and instructions for capturing FHH • Patient report for FHH results |
Indiana University - INGenious: INdiana Genomics Implementation: an Opportunity for the UnderServed | • Eskenazi home-grown EHR system • Automated identification and randomization of patients • Capture of genetic variant data and reporting into EHR • Automatic alerts • Links to guidelines and supporting evidence for patients with pharmacogenomic results | • Directly to providers via CDS within the EHR | • Personal engagement with Eskenazi patient representative organization • Print materials in language-appropriate form in clinics |
Icahn School of Medicine at Mount Sinai - Genetic testing to Understand and Address Renal Disease Disparities (GUARDD) | • Epic-based system that incorporates CLIPMERGE • Alert-based informed message for provider that integrates EHR and allele data • Based on HL7 standards • Integrated with Redcap • CDS alert includes link to provider and patient education materials | • Directly to providers via CDS within the EHR • To patients by research staff trained by genetic counselors • Genetic counselor available for consultation with patients or research staff | • Print materials (low-literacy, culturally appropriate, co-developed with community leaders and APOL1-positive patients) provided to patients at return of result and available for download by clinicians |
University of Florida – UF Health Personalized Medicine Program | • Epic-based system • Alert-based informed message for provider that integrates EHR and allele data • Integrated with Redcap • CDS alert includes link to patient education materials | • Directly to providers via CDS within the EHR | • Print and online materials for patients and clinicians • Continuing education and academic courses for health care professionals and students |
University of Maryland - Genomic Diagnosis and Personalized Therapy for Highly Penetrant Genetic Diabetes | • Epic-based system • Interface of screening tool and algorithm with EHR to produce alert for testing • Integration of actionable result report into EHR • Genetic result-based diagnosis/treatment recommendation alerts | • Direct communication of results to patients and entry into medical record • Customized materials provided to patients for communicating with other family members • If a variant of unknown significance is found, patients will be informed and invited to participate in additional research | • In-person throughout the study process (e.g., patient informed consent conducted by genetic counselor and research coordinator) • For patients with a pathogenic variant, study team and provider will discuss implications • Print materials also provided to patients throughout study |
Vanderbilt University - Integrated, Individualized and Intelligent Prescribing (I3P) Network | • Multiple EHR systems (Epic, Veterans Affairs CPRS, McKesson, home-grown) • Bidirectional • Based on HL7 standards • Incorporates newly developed HL7 genomic data standard • Include interpretative recommendations • Link out to external information sources (e.g., MyCancerGenome.org) • Passive and active alerts | • Directly to providers via CDS within the EHR | • Print and online materials for patients and clinicians • Integrated with CDS • Provider focus groups |