Genet Med. 2018 Nov 23. doi: 10.1038/s41436-018-0378-9. [Epub ahead of print]
Qualitative study of system-level factors related to genomic implementation.
Zebrowski AM1,2, Ellis DE1, Barg FK1,3, Sperber NR4, Bernhardt BA5, Denny JC6,7, Dexter PR8, Ginsburg GS9, Horowitz CR10, Johnson JA11, Levy MA12, Orlando LA9,13, Pollin TI14, Skaar TC15, Kimmel SE16,17,18.
Research on genomic medicine integration has focused on applications at the individual level, with less attention paid to implementation within clinical settings. Therefore, we conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify system-level factors that played a role in implementation of genomic medicine within Implementing GeNomics In PracTicE (IGNITE) Network projects.
Up to four study personnel, including principal investigators and study coordinators from each of six IGNITE projects, were interviewed using a semistructured interview guide that asked interviewees to describe study site(s), progress at each site, and factors facilitating or impeding project implementation. Interviews were coded following CFIR inner-setting constructs.
Key barriers included (1) limitations in integrating genomic data and clinical decision support tools into electronic health records, (2) physician reluctance toward genomic research participation and clinical implementation due to a limited evidence base, (3) inadequate reimbursement for genomic medicine, (4) communication among and between investigators and clinicians, and (5) lack of clinical and leadership engagement.
Implementation of genomic medicine is hindered by several system-level barriers to both research and practice. Addressing these barriers may serve as important facilitators for studying and implementing genomics in practice.
clinical engagement; electronic health record; genomics; implementation; qualitative