Dashed and solid ovals indicate human-initiated and computer-initiated clinical system transactions, respectively. Superscript letters indicate the phase of genetic testing in which clinical system transactions occur (i.e., apreanalytic phase and bpostanalytic phase). Clinical system interactions are illustrated by solid arrows pointing from stakeholders (i.e., clinical-care provider and health-care consumer or family) to clinical systems (i.e., the electronic health record and personal health record systems). EHR, electronic health record; PHR, personal health record.