IOM AC Update. Driving Towards Implementation
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1 IOM AC Update Driving Towards Implementation
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3 Clinical Laboratory
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6 Our Action Collaborative s Strategy Assemble the right organizations Identify areas of agreement Initiate inter-institutional project coordiantion
7 Objective: Build the Foundation Framework for Increasing Support for Genetics in the EHR Ecosystem PGx Use Case Patterns Germline Use Case Patterns Somatic Use Case Patterns Initial PGx Use Case Types Initial PGx Use Case Types Specific Example Specific Example
8 Use Cases Types # Use Case Types 1 Incorporating Genetic Results into EHR User Interfaces 2 Adding genetic tests in order sets 3 Clinical Decision Support (CDS) identifies when a test should be ordered (pre-test alert*) 4 CDS identifes when a drug order is inconsistent with a test result (post-order alert*) * Note pre and post order status refers to the status of the test order as opposed to the drug order
9 The Workflow By: Kristen Janes, Dr. Brian Pech and Priyadarshini Ravindran
10 Current Focus Laboratories Provider EHR Ecosystem Integrated Case Assessment Lab Interpratated Result Identified variants Optional ReInterpretation Process (may occur multiple times) Genetic Test Repository CDS Engine CPOE
11 Interdependency Providers Data Labs
12 Interdependency Providers Data Labs EHR Vendors Interoperability and functionality LIS Vendors Supporting Vendors
13 Interdependency Providers Data Labs EHR Vendors Interoperability and functionality Cooperation / Interfaces LIS Vendors Supporting Vendors
14 Interdependency Providers Data Labs EHR Vendors Interoperability and functionality Cooperation / Interfaces LIS Vendors Supporting Vendors Standards and Ontologies Standards & Ontology Organizations
15 Interdependency Providers Data Labs EHR Vendors Interoperability and functionality Cooperation / Interfaces LIS Vendors Supporting Vendors Input Standards and Ontologies Standards & Ontology Organizations
16 Interdependency Funding / Reimbursement Environment that Makes this Possible Providers Data Labs EHR Vendors Interoperability and functionality Cooperation / Interfaces LIS Vendors Gov Agencies Supporting Vendors Input Standards and Ontologies Standards & Ontology Organizations
17 Interdependency Funding / Reimbursement Environment that Makes this Possible Providers Data Labs Interoperability and functionality Cooperation / Interfaces EHR Vendors LIS Vendors Proof of what is possible/helpful Gov Agencies Supporting Vendors Input Standards and Ontologies Standards & Ontology Organizations
18 Action Collaborative Membership Sandy Aronson (Partners, GeneInsight) Jane Atkinson (NIDCR) Larry Babb (Partners, GeneInsight) Dixie Baker (Martin Blanck) Gillian Bell (Moffitt) Kelly Caudle (St. Jude) Sri Denduluri (Allscripts) Robert Freimuth (Mayo) Jennifer Hall (U. of Minnesota) Heather Halvorson (DOD) Stan Huff (Intermountain) Kristen Janes (Kaiser) Andrew Kasarskis (MSSM) Anthony Kerlavage (NCI) Warren Kibbe (NCI) Debra Leonard (U. of Vermont) Ira Lubin (CDC) Elaine Lyon (ARUP) Larry Meyer (VA) Scott Moss (Epic) Blackford Middleton (Vanderbilt) J.D. Nolen (Cerner) James O'Leary (Genetic Alliance) Erin Payne (Northrop Grumman) Brian Pech (Kaiser) Priya Ravindran (Allscripts) Mary Relling (St. Jude) Todd Rothenhaus (AthenaHealth) Hoda Sayed-Friel (Meditech) Megan Schmidt (Sunquest) Sam Shekar (Northrop Grumman) Brian Shirts (U. of Washington) Jamie Skipper (ONC) Brad Strock (Epic) Sandra Stuart (Kaiser) Jeff Struewing (NHGRI) Chuck Tuchinda (First Databank) Scott Weiss (Partners HealthCare) Bob Wildin (NHGRI) Ken Wiley (NHGRI) Marc Williams (Geisinger) Grant Wood (Intermountain)
19 Making it Happen Labs Providers Lab and HealthCare Provider Share their Clinical Perspectives on Use Case Definition and Refinement ARUP DOD Intermountain HealthCare St. Jude Kaiser Partners HealthCare Mayo MSSM U of Minnesota Moffitt St. Jude Vanderbuilt VA U of Vermont U of Washington
20 Making it Happen Labs Providers EHR Vendors LIS Vendors Allscripts AthenaHealth Cerner Epic First Databank GeneInsight Meditech Northrop Grumman Sunquest Supporting Vendors Define what can be done now and what is needed to establish deeper support
21 Making it Happen Labs Providers EHR Vendors LIS Vendors Supporting Vendors Standards & Ontology Organizations AMIA CAP CDC ClinGen CPIC Global Alliance HL7 HSPC LOINC Representatives focused on deepening support CPIC and ClinGen working together on ontologies HL7 and LOINC strategy under development New members recruited from additional bodies we believe can help
22 Making it Happen Labs Providers EHR Vendors CDC DOD NCI NIDCR NHGRI ONC LIS Vendors Supporting Vendors Standards & Ontology Organizations Government Funding and Incentive Context Government actions could accelerate development of support
23 Use Cases Types # Use Case Types 1 Incorporating Genetic Results into EHR User Interfaces 2 Adding genetic tests in order sets 3 Clinical Decision Support (CDS) identifies when a test should be ordered (pre-test alert*) 4 CDS identifes when a drug order is inconsistent with a test result (post-order alert*) * Note pre and post order status refers to the status of the test order as opposed to the drug order
24 Use Case Type 4 Use Case Example Imuran Dosing Warn clinicians who prescribe over 50 mg / day of Imuran to adult patients who are low metabolizers of the drug Enable clinician to override alert Enable clinician to suppress alert for future orders Record alert overrides and suppressions in audit trail
25 Specific Type 4 Use Case Example Abacavir Hypersensitivity Warn clinicians who prescribe Abacavir to a patient with a genetic test result that indicates they will be hypersensitive
26 Key Concepts Lab Interpreted Result Variants
27 Interdependency Funding / Reimbursement Environment that Makes this Possible Providers Data Labs Interoperability and functionality Cooperation / Interfaces EHR Vendors LIS Vendors Proof of what is possible/helpful Gov Agencies Supporting Vendors Input Standards and Ontologies Standards & Ontology Organizations
28 What this is Really About Providers Labs EHR Vendors Cooperation / Interfaces LIS Vendors Supporting Vendors Patients Gov Agencies Standards & Ontology Organizations
29 What this is Really About Providers Labs Cooperation / Interfaces EHR Vendors LIS Vendors Supporting Vendors Patients Gov Agencies Deliver the promise of genomics to fundamentally improve the care of themselves and their families Standards & Ontology Organizations
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