Bringing the EHR into the practice of precision medicine and genomics

A nurse leader at the National Institutes of Health discusses the progress the organization is making with incorporating genomics information into an EHR.
NIH precision medicine EHR

Precision medicine and genomics are innovations just starting to work their way into the mainstream of healthcare. And electronic health records are beginning to catch up with early use of precision medicine.

As a healthcare research organization, the National Institutes of Health has the challenge of integrating genomics into its daily routine with a number of growing protocols. In this field, besides the overabundance of genetic lab results, one of the basic tools clinicians use is the genomic pedigree. And over the past several years, the NIH has prepared its nursing staff with practical genomics skills. The organization’s goal is to give clinicians the genomics tools they need within their EHR.

“No major EHR vendor has native genomics tools or functionality – there are a variety of third-party genomics applications offered, but nothing standard and fully integrated,” said Michelle Lardner, RN, deputy CIO, clinical informatics, in the department of clinical research informatics at the NIH. “It was a challenge at first, but it has been an exciting journey with nursing and our vendor to develop a tool that can be used at the organization. For those clinicians who practice genomics, having this tool to use in the EHR is a must.”

Lardner will speak on the subject at HIMSS18 during a March 7 educational session entitled “Genomics nursing and the EHR.”

The National Institutes of Health uses an EHR from Allscripts, with precision medicine functionality from 2bPrecise. There are many important aspects to bringing genomics into clinical practice and into an EHR environment. Lardner offers insights into two.

“Describe basic genomics nursing skills,” she said. “Genomics is a central science for nursing practice because essentially all diseases and conditions have a genetic or genomic component. Meaningful use was a great way to start the family history conversation. As organizations start utilizing genomics in treating patients, creating a pedigree from the family medical history becomes a skill that nurses should have.”

And caregivers must identify limitations in the EHR related to genomics, she added. EHRs have much to offer; however, besides the basic family history documentation, there is no place to create or document a pedigree. This is basic foundational documentation that is used in the practice of genomics, she said.

“Precision medicine and genomics are medical innovations that are becoming mainstream,” Lardner said. “EHRs need to catch up to this practice. If an organization is looking into offering precision medicine services to their patients, it will need the tools to effectively and efficiently do this.”

Michelle Lardner will be speaking in the session, “Genomics nursing and the EHR,” at 11:30 a.m. March 7 in the Venetian, Galileo 901.

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