In general, resources need to be shifted toward translational research, said Feero, and this research needs to illuminate the economics of adapting new technologies.

Ethical, Legal, and Social Issues and Education

In the area of ethical, legal, and social issues, outcomes data on informed consent is a major need, cited Feero. What kind of informed consent is appropriate in the relationship between provider and patient?

In the area of education, Feero asked, can more efficient methods for patient and provider education be developed? Also, genomic scientists and clinicians need education about economic analyses applied to genomic tests.

Health Services

Health systems will need new methods and a stronger infrastructure, including informatics, to track and analyze the downstream consequences of providing sequence data, said Feero. For example, do codes exist that will follow what happens when genomic information is made available?

When should genomic sequencing be done during the lifespan of an individual, Feero asked. Possibilities range from having the complete sequence available at birth to conducting targeted sequencing at the time of diagnosis. If genomic results that are already available are more likely to be used than results that need to be obtained after the patient presents themselves, this raises the question of thresholds for the use and generation of evidence.

Knowledge gained from new technologies may not be applicable to all populations because not all populations are represented in research, noted Feero, which could heighten disparities in health care. Efforts should be invested in determining how new technologies could exacerbate or ameliorate existing disparities. However, it is important to remember that this issue is not specific to genomics.

Finally, asked Feero, in a world of stable or declining resources, do accountable care organizations provide a model for producing more efficient health care using genomic technologies?

The Need for a Systems Perspective

All these issues need to be considered from a systems perspective, said Feero. Most researchers, including economists, consider problems within a particular context and develop a carefully designed question, which produces an internally consistent and robust answer for that question. But any such problem is just part of a much larger overall picture. Particularly



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