Abstract
Family health history is a leading predictor of disease risk. Nonetheless, it is underutilized to guide care and, therefore, is ripe for health information technology intervention. To fill the family health history practice gap, Cleveland Clinic has developed a family health history collection and clinical decision support tool, MyFamily. This report describes the impact and process of implementing MyFamily into primary care, cancer survivorship and cancer genetics clinics. Ten providers participated in semi-structured interviews that were analyzed to identify opportunities for process improvement. Participants universally noted positive effects on patient care, including increases in quality, personalization of care and patient engagement. The impact on clinical workflow varied by practice setting, with differences observed in the ease of integration and the use of specific report elements. Tension between the length of the report and desired detail was appreciated. Barriers and facilitators to the process of implementation were noted, dominated by the theme of increased integration with the electronic medical record. These results fed real-time improvement cycles to reinforce clinician use. This model will be applied in future institutional efforts to integrate clinical genomic applications into practice and may be useful for other institutions considering the implementation of tools for personalizing medical management.
Highlights
There is increasing acceptance among practicing clinicians that health informatics, in general, and clinical decision support (CDS) tools, in particular, can be used to improve the quality and consistency of healthcare delivery, playing a fundamental role in both standardizing and personalizing approaches to care [1–6]
A total of 10 clinicians participated in the formative evaluation, including four primary care physicians, four genetic counselors and two advanced practice nurses
Clinicians universally agreed that MyFamily would increase the quality and consistency of care received by patients, appropriately flagging those at high risk for additional screening/referral, more in-depth/targeted counseling, facilitating a personalized approach to risk management and allowing for appropriate reassurance of the ―worried well.‖ primary care (PC) and cancer survivorship (CS) clinicians commented on the shift in their family health history conversations from gathering to using the information provided to make management decisions, as well as having more nuanced conversations about the risks pertinent to their particular patient
Summary
There is increasing acceptance among practicing clinicians that health informatics, in general, and clinical decision support (CDS) tools, in particular, can be used to improve the quality and consistency of healthcare delivery, playing a fundamental role in both standardizing and personalizing approaches to care [1–6]. Despite its acknowledged importance for identifying risk factors for eight of the top ten leading causes of death in the U.S, family health history is unsystematically collected and inconsistently applied to guide medical care [7–10]. For this reason, family health history is ripe for health informatics-based interventions, including CDS [11–14]. Education in Genetics, Partners Healthcare and Genetic Alliance. All of these tools are electronic, patient-entered family health history questionnaires. All but OurFamilyTree include CDS, none provide this support directly through the electronic medical record (EMR)
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