Table 3.

Strategies for storing genetic and genomic test results in electronic health records (EHRs)

Storage strategy	Pros	Cons
Detailed results stored in EHR as a laboratory result (e.g., each SNP, insertion/deletion)	All information about the test result is available directly from the EHR Changes to how genetic variants are interpreted are immediately actionable through decision support	Significant storage needed for EHRs Introduces more results that must be sorted/filtered when reviewing laboratory results Complex decision support logic and reasoning is required within the EHR
Point-in-time interpretation	Reduced storage requirements in the EHR Computable result may be integrated into decision support	Loss of detailed information regarding genetic results Requires retesting and reinterpretation if knowledge about affected variants changes over time
External data warehouse linked back to EHR	Same benefits as the point-in-time interpretation Preserves original data, allowing review and reinterpretation of the results as needed Interpretation of genomic results may take advantage of more advanced computational approaches not available within EHRs Allows time for best practice evaluation and integration into the clinical workflow	Requires development and maintenance of a robust interface to integrate back into the EHR Investment in creation and maintenance of the ancillary storage system

SNP, single-nucleotide polymorphism.