Subjects

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

We thank Selena Suhail-Sindhu, recent graduate of the public health program at Columbia University, for her assistance with data collection and management, and Kara Silberthau, medical student at the University of Pennsylvania, for her contribution to data management and analysis. Support for this study was provided from the Implementation Science Working Group at the University of Pennsylvania and the NHGRI U01-HG007266. Additional IGNITE network grants include U01-HG007269, U01-HG007253, U01-HG007762, U01-HG007282, U01-HG007775, and U01-HG007278.

Author information

Affiliations

  1. Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA

    • Alexis M. Zebrowski MPH
    • , Darcy E. Ellis MPH
    • , Frances K. Barg PhD, MEd
    •  & Stephen E. Kimmel MD, MSCE
  2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    • Alexis M. Zebrowski MPH
    •  & Stephen E. Kimmel MD, MSCE
  3. Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA

    • Frances K. Barg PhD, MEd
  4. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA

    • Nina R. Sperber PhD, MA
  5. Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    • Barbara A. Bernhardt MS, CGC
  6. Departments of Biomedical Informatics and Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    • Joshua C. Denny MD, MS
  7. Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    • Joshua C. Denny MD, MS
  8. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    • Paul R. Dexter MD
  9. Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, NC, USA

    • Geoffrey S. Ginsburg MD, PhD
    •  & Lori A. Orlando MD, MHS
  10. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    • Carol R. Horowitz MD, MPH
  11. Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida College of Pharmacy, Gainesville, FL, USA

    • Julie A. Johnson PharmD
  12. Departments of Biomedical Informatics and Medicine, Division of Hematology and Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA

    • Mia A. Levy MD, PhD
  13. Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    • Lori A. Orlando MD, MHS
  14. University of Maryland School of Medicine, Baltimore, MD, USA

    • Toni I. Pollin PhD, CGC
  15. Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA

    • Todd C. Skaar PhD
  16. Department of Medicine, Pearlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    • Stephen E. Kimmel MD, MSCE

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Disclosure

The authors declare no conflicts of interest.

Corresponding author

Correspondence to Stephen E. Kimmel MD, MSCE.

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DOI

https://doi.org/10.1038/s41436-018-0378-9