BACKGROUND: Emergence of genomic medicine as a new approach to healthcare follows technological advances in sequencing the human genome and harnessing big datasets. Clinical decision support (CDS) commonly guides clinicians in use and interpretation of personalized data; however, best strategies for integrating into routine care need an evidence-base. We sought to identify and describe core implementation strategies for desired outcomes among members of the Implementing Genomics in Medicine (IGNITE) network.
METHODS: Participants included six diverse projects led by academic medical centers allied with community healthcare systems. All projects implemented CDS tools into an EHR system: three implemented different pharmacogenomics (PGx) CDS interventions in the EHR and three focused on disease risk or etiology. To obtain detail about implementation strategies and desired outcomes, we adapted a published survey derived from a typology of 73 implementation strategies grouped into thematic clusters, the Expert Recommendations for Implementing Change (ERIC), and conducted follow-up interviews guided by implementation strategy reporting criteria (Proctor 2013) and a planning framework, RE-AIM.
FINDINGS: On average, the projects implemented 32 ERIC strategies (range 11–47). The three PGx projects each used more strategies (40-47) compared to the disease-focused ones (11–29). Despite diverse project goals and approaches, all six projects commonly used four strategies from three clusters: (1) developing strategies to obtain and use stakeholder feedback (cluster—using evaluative and iterative strategies), (2) identifying early adopters (cluster—developing stakeholder interrelationships), (3) conducting educational meetings (cluster—training and educating stakeholders), and (4) having an expert meet with clinicians to educate them (cluster—training and educating stakeholders). Detailed reporting criteria revealed different manifestations of the strategies across the projects and a need to integrate the training and educating stakeholder strategies in reporting. Implications for D&I Research: This project represents the first application of the full ERIC typology in conjunction with Proctor’s detailed reporting criteria to genomic medicine implementation. ERIC, developed in the context of mental health research and practice, provides a useful guide for highlighting generalizable core strategies as a starting point; however, it did not capture all relevant strategies. We present ideas for future work to develop a version of the ERIC typology specifically for genomic medicine implementation.
