Zebrowski, Alexis M.Ellis, Darcy E.Barg, Frances K.Sperber, Nina R.Bernhardt, Barbara A.Denny, Joshua C.Dexter, Paul R.Ginsburg, Geoffrey S.Horowitz, Carol R.Johnson, Julie A.Levy, Mia A.Orlando, Lori A.Pollin, Toni I.Skaar, Todd C.Kimmel, Stephen E.2019-08-132019-08-132019-07Zebrowski, A. M., Ellis, D. E., Barg, F. K., Sperber, N. R., Bernhardt, B. A., Denny, J. C., … Kimmel, S. E. (2019). Qualitative study of system-level factors related to genomic implementation. Genetics in medicine : official journal of the American College of Medical Genetics, 21(7), 1534–1540. doi:10.1038/s41436-018-0378-9https://hdl.handle.net/1805/20344PURPOSE: 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.en-USPublisher PolicyImplementationQualitativeGenomicsElectronic Health RecordClinical EngagementArticle