Integrating Somatic and Germline Next-Generation Sequencing Into Routine Clinical Oncology Practice.

Next-generation sequencing (NGS) is rapidly expanding into routine oncology practice. Genetic variations in both the cancer and inherited genomes are informative for hereditary cancer risk, prognosis, and treatment strategies. Herein, we focus on the clinical perspective of integrating NGS results into patient care to assist with therapeutic decision making. Five key considerations are addressed for operationalization of NGS testing and application of results to patient care as follows: (1) NGS test ordering and workflow design; (2) result reporting, curation, and storage; (3) clinical consultation services that provide test interpretations and identify opportunities for molecularly guided therapy; (4) presentation of genetic information within the electronic health record; and (5) education of providers and patients. Several of these key considerations center on informatics tools that support NGS test ordering and referencing back to the results for therapeutic purposes. Clinical decision support tools embedded within the electronic health record can assist with NGS test utilization and identifying opportunities for targeted therapy including clinical trial eligibility. Challenges for project and change management in operationalizing NGS-supported, evidence-based patient care in the context of current information technology systems with appropriate clinical data standards are discussed, and solutions for overcoming barriers are provided.

Correction to: Development and Optimization of Clinical Informatics Infrastructure to Support Bioinformatics at an Oncology Center.

The book has been inadvertently published with wrong affiliation for the corresponding author, Randa M. Perkins, of chapter 1. It has now been updated as below in this revised version of the book.

Development and Optimization of Clinical Informatics Infrastructure to Support Bioinformatics at an Oncology Center.

Translational bioinformatics for therapeutic discovery requires the infrastructure of clinical informatics. In this chapter, we describe the clinical informatics components needed for successful implementation of translational research at a cancer center. This chapter is meant to be an introduction to those clinical informatics concepts that are needed for translational research. For a detailed account of clinical informatics, the authors will guide the reader to comprehensive resources. We provide examples of workflows from Moffitt Cancer Center led by Drs. Perkins and Markowitz. This perspective represents an interesting collaboration as Dr. Perkins is the Chief Medical Information Officer and Dr. Markowitz is a translational researcher in Melanoma with an active informatics component to his laboratory to study the mechanisms of resistance to checkpoint blockade and an active member of the clinical informatics team.

Reducing Alert Burden in Electronic Health Records: State of the Art Recommendations from Four Health Systems.

BACKGROUND: Electronic health record (EHR) alert fatigue, while widely recognized as a concern nationally, lacks a corresponding comprehensive mitigation plan. OBJECTIVES: The goal of this manuscript is to provide practical guidance to clinical informaticists and other health care leaders who are considering creating a program to manage EHR alerts. METHODS: This manuscript synthesizes several approaches and recommendations for better alert management derived from four U.S. health care institutions that presented their experiences and recommendations at the American Medical Informatics Association 2019 Clinical Informatics Conference in Atlanta, Georgia, United States. The assembled health care institution leaders represent academic, pediatric, community, and specialized care domains. We describe governance and management, structural concepts and components, and human-computer interactions with alerts, and make recommendations regarding these domains based on our experience supplemented with literature review. This paper focuses on alerts that impact bedside clinicians. RESULTS: The manuscript addresses the range of considerations relevant to alert management including a summary of the background literature about alerts, alert governance, alert metrics, starting an alert management program, approaches to evaluating alerts prior to deployment, and optimization of existing alerts. The manuscript includes examples of alert optimization successes at two of the represented institutions. In addition, we review limitations on the ability to evaluate alerts in the current state and identify opportunities for further scholarship. CONCLUSION: Ultimately, alert management programs must strive to meet common goals of improving patient care, while at the same time decreasing the alert burden on clinicians. In so doing, organizations have an opportunity to promote the wellness of patients, clinicians, and EHRs themselves.

Examining the adoption of electronic health records and personal digital assistants by family physicians in Florida.

PURPOSE: The purpose of this paper is to comprehensively characterise the current use of electronic health records (EHRs) and personal digital assistants (PDAs) among family physicians in Florida; and to compare family physicians with other doctors with respect to the functions commonly used on their EHR and PDA systems. METHODS: A postal survey was sent to family physicians (n=2076) and other doctors with a clear and active licence in Florida (total n=14 921). To examine factors among family physicians related to EHR and PDA use, binary logistic regression modelling techniques were utilised. Chi-square analysis was used to compare EHR and PDA functions between family physicians and other doctors. RESULTS: A total of 4203 responses, of which 756 were from family physicians, were available for the current study (28.2% overall response rate). EHR use among family physicians was significantly related to large practice size, urban location and young physician age, after controlling for confounders. Likewise, PDA usage among family physicians was independently associated with male gender and younger physician age. Additionally, even though no differences in overall EHR adoption were found, family physicians, when compared with other physicians, were significantly more likely to be using a more robust set of EHR functions. This included allergy and medication lists, diagnosis, problem lists, patient scheduling and educational materials, preventive services reminders and access to reference material. CONCLUSIONS: Even though family physicians utilise many EHR and PDA functions more commonly than other physician groups, the overall level of EHR adoption among family physicians remains low. Until more barriers to the use of EHR are minimised, the goals of the Future of Family Medicine Report to broadly implement EHR and other health IT functions will not be fully realised.