Table 2 Genomic medicine: Barriers to implementation.
Lack of evidence of the effectiveness of genomic interventions and related codependent technologies* as well as expertise and training programs in genetics, genomics, informatics, and statistics
High cost and lack of reimbursement for tests and codependent technologies
Need for evidentiary thresholds for genomic testing; quality-control standards for genome technologies; and databases with genomic variants linked to clinical phenotypes
Lack of consensus on what investments are needed in research and health care capacity for effective, sustainable implementation
Limited access to educational information and reliable standardized genotyping or sequencing platforms
Lack of bioinformatics and EMR infrastructure to order, receive, act on, and follow up results and assess the impact of clinical interventions
Concerns over consent and privacy
Need to align genomic research with the future burden of disease and health needs of patients and populations and the development of genomic tests with the development of effective co-dependent technologies
Need to consider ethical and legal aspects of the ownership of genomic information and manage competing interests in a fair and transparent manner

*A codependent health technology is one that depends on a second technology to achieve or enhance the intended effect, such as a diagnostic test used to determine a patient subgroup that is most likely to respond to a new medication. []