Screening for Familial Hypercholesterolemia using Epic Secure Chat in Comparison to Epic Letter as Educational Outreach˄

Abstract

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Familial hypercholesterolemia (FH) is an autosomal dominant disorder involved LDL-c uptake and metabolism. It occurs in 1:200-250 individuals. If untreated, FH confers an increased risk of ASCVD. In the USA, approximately 5% of all MIs are caused by FH. However only 1-10% of these cases have been identified. This underdiagnosis places an immense burden on individuals and the health care system. Atlantic Health System (AHS) is a clinical site for the national Cascade FH Registry, with the goal to identify patients and their families with FH. There are many barriers to screening including financial, social, and legal considerations. One of these barriers is the lack of general awareness to recognize FH among many primary care physicians (PCP)s. <h3>Objective/Purpose</h3> In this study we used our electronic medical record (EMR) EPIC Chat to screen for FH by contacting PCPs. In 2019, we contacted PCPs using Epic Letter and generated a 6% response rate. We predicted that using Epic Chat we would have a larger response. <h3>Methods</h3> Our EMR database consist of 1,004 clinicians including 195 PCPs and 404,595 unique patients. We identified approximately 1,000 patients with LDL >160 mg/dL and selected 200 patients with probable FH. We contacted their PCPs via Epic Chat by using the same IRB approved letter we used a year prior to send Epic Letters. <h3>Results</h3> Epic Chat generated a response of 28% (n=56) compared to our prior response rate of 6.5% (n=13) using Epic Letter. Most physicians responded immediately. They were interested and thankful to learn about our educational outreach. <h3>Conclusions</h3> Our outreach with Epic Chat generated a robust response compared to Epic Letter. Epic Chat is embedded in the Epic workflow, facilitating an immediate response and dialogue among users. Since our present study is two years later, it is possible that our screening program has become better known. However, it is unlikely to explain such a large difference in response. We believe this study shows by using EPIC Chat, screening programs designed to reach PCPs can be greatly improved.