Qualitative study of system-level factors related to genomic implementation

Alexis M. Zebrowski, Darcy E. Ellis, Frances K. Barg, Nina R. Sperber, Barbara A. Bernhardt, Joshua C. Denny, Paul R. Dexter, Geoffrey S. Ginsburg, Carol R. Horowitz, Julie A. Johnson, Mia A. Levy, Lori A. Orlando, Toni I. Pollin, Todd C. Skaar, Stephen E. Kimmel

Research output: Contribution to journalArticle

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1534-1540
Number of pages7
JournalGenetics in Medicine
Issue number7
StatePublished - Jul 1 2019


  • clinical engagement
  • electronic health record
  • genomics
  • implementation
  • qualitative

ASJC Scopus subject areas

  • Genetics(clinical)

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    Zebrowski, A. M., Ellis, D. E., Barg, F. K., Sperber, N. R., Bernhardt, B. A., Denny, J. C., Dexter, P. R., Ginsburg, G. S., Horowitz, C. R., Johnson, J. A., Levy, M. A., Orlando, L. A., Pollin, T. I., Skaar, T. C., & Kimmel, S. E. (2019). Qualitative study of system-level factors related to genomic implementation. Genetics in Medicine, 21(7), 1534-1540. https://doi.org/10.1038/s41436-018-0378-9