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  1. Article ; Online: Clinician-centric diagnosis of rare genetic diseases

    Michael M. Segal / Renee George / Peter Waltman / Ayman W. El-Hattab / Kiely N. James / Valentina Stanley / Joseph Gleeson

    Orphanet Journal of Rare Diseases, Vol 15, Iss 1, Pp 1-

    performance of a gene pertinence metric in decision support for clinicians

    2020  Volume 10

    Abstract: Abstract Background In diagnosis of rare genetic diseases we face a decision as to the degree to which the sequencing lab offers one or more diagnoses based on clinical input provided by the clinician, or the clinician reaches a diagnosis based on the ... ...

    Abstract Abstract Background In diagnosis of rare genetic diseases we face a decision as to the degree to which the sequencing lab offers one or more diagnoses based on clinical input provided by the clinician, or the clinician reaches a diagnosis based on the complete set of variants provided by the lab. We tested a software approach to assist the clinician in making the diagnosis based on clinical findings and an annotated genomic variant table, using cases already solved using less automated processes. Results For the 81 cases studied (involving 216 individuals), 70 had genetic abnormalities with phenotypes previously described in the literature, and 11 were not described in the literature at the time of analysis (“discovery genes”). These included cases beyond a trio, including ones with different variants in the same gene. In 100% of cases the abnormality was recognized. Of the 70, the abnormality was ranked #1 in 94% of cases, with an average rank 1.1 for all cases. Large CNVs could be analyzed in an integrated analysis, performed in 24 of the cases. The process is rapid enough to allow for periodic reanalysis of unsolved cases. Conclusions A clinician-friendly environment for clinical correlation can be provided to clinicians who are best positioned to have the clinical information needed for this interpretation.
    Keywords Rare disease diagnosis ; Diagnostic decision support system ; Artificial intelligence ; Genomic analysis ; Copy number variation ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2020-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: User testing of a diagnostic decision support system with machine-assisted chart review to facilitate clinical genomic diagnosis

    Conner Jenkins / Troy Jenkins / Thomas N Person / Peter N Robinson / Alanna Kulchak Rahm / Nephi A Walton / Lynn K Feldman / Joeseph Peterson / Jonathon C Reynolds / Makenzie A Woltz / Marc S Williams / Michael M Segal

    BMJ Health & Care Informatics, Vol 28, Iss

    2021  Volume 1

    Abstract: Objectives There is a need in clinical genomics for systems that assist in clinical diagnosis, analysis of genomic information and periodic reanalysis of results, and can use information from the electronic health record to do so. Such systems should be ... ...

    Abstract Objectives There is a need in clinical genomics for systems that assist in clinical diagnosis, analysis of genomic information and periodic reanalysis of results, and can use information from the electronic health record to do so. Such systems should be built using the concepts of human-centred design, fit within clinical workflows and provide solutions to priority problems.Methods We adapted a commercially available diagnostic decision support system (DDSS) to use extracted findings from a patient record and combine them with genomic variant information in the DDSS interface. Three representative patient cases were created in a simulated clinical environment for user testing. A semistructured interview guide was created to illuminate factors relevant to human factors in CDS design and organisational implementation.Results Six individuals completed the user testing process. Tester responses were positive and noted good fit with real-world clinical genetics workflow. Technical issues related to interface, interaction and design were minor and fixable. Testers suggested solving issues related to terminology and usability through training and infobuttons. Time savings was estimated at 30%–50% and additional uses such as in-house clinical variant analysis were suggested for increase fit with workflow and to further address priority problems.Conclusion This study provides preliminary evidence for usability, workflow fit, acceptability and implementation potential of a modified DDSS that includes machine-assisted chart review. Continued development and testing using principles from human-centred design and implementation science are necessary to improve technical functionality and acceptability for multiple stakeholders and organisational implementation potential to improve the genomic diagnosis process.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 670
    Language English
    Publishing date 2021-07-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Experience with Integrating Diagnostic Decision Support Software with Electronic Health Records

    Michael M. Segal / Alanna K. Rahm / Nathan C. Hulse / Grant Wood / Janet L. Williams / Lynn Feldman / Gregory J. Moore / David Gehrum / Michelle Yefko / Steven Mayernick / Roger Gildersleeve / Margie C. Sunderland / Steven B. Bleyl / Peter Haug / Marc S. Williams

    eGEMs, Vol 5, Iss

    Benefits versus Risks of Information Sharing

    2017  Volume 1

    Abstract: Introduction: Reducing misdiagnosis has long been a goal of medical informatics. Current thinking has focused on achieving this goal by integrating diagnostic decision support into electronic health records. Methods: A diagnostic decision support system ... ...

    Abstract Introduction: Reducing misdiagnosis has long been a goal of medical informatics. Current thinking has focused on achieving this goal by integrating diagnostic decision support into electronic health records. Methods: A diagnostic decision support system already in clinical use was integrated into electronic health record systems at two large health systems, after clinician input on desired capabilities. The decision support provided three outputs: editable text for use in a clinical note, a summary including the suggested differential diagnosis with a graphical representation of probability, and a list of pertinent positive and pertinent negative findings (with onsets). Results: Structured interviews showed widespread agreement that the tool was useful and that the integration improved workflow. There was disagreement among various specialties over the risks versus benefits of documenting intermediate diagnostic thinking. Benefits were most valued by specialists involved in diagnostic testing, who were able to use the additional clinical context for richer interpretation of test results. Risks were most cited by physicians making clinical diagnoses, who expressed concern that a process that generated diagnostic possibilities exposed them to legal liability. Discussion and Conclusion: Reconciling the preferences of the various groups could include saving only the finding list as a patient-wide resource, saving intermediate diagnostic thinking only temporarily, or adoption of professional guidelines to clarify the role of decision support in diagnosis.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 050
    Language English
    Publishing date 2017-12-01T00:00:00Z
    Publisher Ubiquity Press
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article: An international effort towards developing standards for best practices in analysis, interpretation and reporting of clinical genome sequencing results in the CLARITY Challenge

    Brownstein, Catherine A / A Micheil Innes / Aaron Bossler / Adam P DeLuca / Aiden E Shearer / Alan H Beggs / Aleš Maver / Alexander G Bassuk / Alexander Hahn / Alexander Hoischen / Alexander T Rakowsky / Ali Torkamani / Andrey Alexeyenko / Anja Palandačić / Anna Wedell / Anne Kwitek / Asif Javed / Austin C Alexander / Barry M Moore /
    Barry Merriman / Bartha M Knoppers / Benjamin Darbro / Bernward Klocke / Birgit H Funke / Borut Peterlin / Bregje van Bon / Bruce E Bray / C Thomas Caskey / Can Yang / Christian Gilissen / Christian R Marshall / Christopher A Cassa / Christopher R Pierson / Claudia Gugenmus / Colleen A Campbell / Cong Li / Daniel G MacArthur / Daniel Nilsson / Daniel R Richards / David A Stevenson / David M Margulies / David McCallie Jr / David Newsom / Denise Mauldin / Deniz Kural / Dennis E Bulman / Devon Lamb-Thrush / Diana L Kolbe / Domingo González-Lamuño / Donald Corsmeier / Douglas Van Daele / E Ann Black-Ziegelbein / Edward Kiruluta / Edwin M Stone / Eitan Friedman / Elaine Lyon / Elizabeth T DeChene / Emily N Price / Eran Halperin / Erik Edens / F Anthony San Lucas / Fang Fang / Francisco M De La Vega / Fulya Taylan / Gail Herman / Gerard Tromp / Gholson J Lyon / Greg G Lennon / Gustavo Glusman / Hannah C Cox / Hatice Duzkale / Heather M McLaughlin / Heidi L Rehm / Hela Azaiez / Helger Yntema / Henrik Stranneheim / Hongyu Zhao / Huntington F Willard / Ignacio Varela / Ignaty Leshchiner / Ingrid A Holm / Isaac S Kohane / Ivan Adzhubey / Jacek Majewski / Janeen L Andorf / Jared C Roach / Jason Sager / Javier Llorca / Jeremy Schwartzentruber / Jessica M Lindvall / Jian Huang / Jillian S Parboosingh / Jochen Supper / Jon M Sorenson / Jonathan W Heusel / Jorge Barrera / Joseph Majzoub / Juan Caballero / Juan M Garcia-Lobo / Kai Wang / Karen Eilbeck / Karin Panzer / Kasper Lage / Katherine C Flannery / Katherine Mathews / Kathryn Blair / Kelli Ryckman / Kevin Booth / Kim L McBride / Komal S Sandhu / Kym M Boycott / Laurent Francioli / Lee Rowen / Lin Hou / Livija Medne / Lovelace J Luquette / Lu Zhang / Luca Lovrečić / Måns Magnusson / Manuel L Gonzalez-Garay / Marc S Williams / Marcel Nelen / Maria C Rodriguez / Mario Deng / Mark E Samuels / Mark Yandell / Martin Braun / Martin G Reese / Matthew S Lebo / Max Schubach / Meghan C Towne / Mengjie Chen / Michael Cariaso / Michael F Murray / Michael M Segal / Michele Cargill / Mikael Huss / Monica A Giovanni / Monkol Lek / Mortiz Menzel / Murat Gunel / Nancy J Mendelsohn / Nathan O Stitziel / Nic Meyer / Nils Homer / Noam Shomron / Ofer Isakov / Oleg A Shchelochkov / Pamela Trapane / Paul IW de Bakker / Paul MK Gordon / Pauline C Ng / Paz P Polak / Peining Li / Peter Freisinger / Peter Neupert / Peter Szolovits / Peter White / Piotr Dworzyński / Rachel Soemedi / Rama Sompallae / Reece K Hart / Renee Temme / Richard JH Smith / Richard S Finkel / Robert E Handsaker / Sabrina W Yum / Saloni Agrawal / Sara Fitzgerald-Butt / Sara Vestecka / Sarah K Savage / Sarah L Sawyer / Saskia Biskup / Seth A Ament / Shamil R Sunyaev / Shuba Krishna / Soumya Raychaudhuri / Steven A Moore / Sven Perner / Tara Maga / Terry A Braun / Thomas Bair / Thomas Wassink / Timothy W Yu / Todd E Scheetz / Tune H Pers / Val C Sheffield / Vamsi Veeramachaneni / Weidong Zhang / William Fairbrother / Xiaowei Chen / Xiting Yan / Yan Zhang / Ying Huang / Yong Kong / Yu Bai / Zayed I Albertyn / Zhengyuan Wang

    Genome biology. 2014 Mar., v. 15, no. 3

    2014  

    Abstract: BACKGROUND: There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data ... ...

    Abstract BACKGROUND: There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. RESULTS: A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. CONCLUSIONS: The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups.
    Keywords bioinformatics ; DNA ; genetic disorders ; nucleotide sequences ; patients ; research methods ; sequence analysis
    Language English
    Dates of publication 2014-03
    Size p. 3357.
    Publishing place Springer-Verlag
    Document type Article
    ZDB-ID 2040529-7
    ISSN 1474-760X ; 1465-6914 ; 1465-6906
    ISSN (online) 1474-760X ; 1465-6914
    ISSN 1465-6906
    DOI 10.1186/gb-2014-15-3-r53
    Database NAL-Catalogue (AGRICOLA)

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