Abstract
Family health history (FHH) screening plays a key role in disease risk identification and tailored disease prevention strategies. Primary care physicians (PCPs) are in a frontline position to provide personalized medicine recommendations identified through FHH screening; however, adoption of FHH screening tools has been slow and inconsistent in practice. Information is also lacking on PCP facilitators and barriers of utilizing family history tools with clinical decision support (CDS) embedded in the electronic health record (EHR). This study reports on PCPs’ initial experiences with the Genetic and Wellness Assessment (GWA), a patient-administered FHH screening tool utilizing the EHR and CDS. Semi-structured interviews were conducted with 24 PCPs who use the GWA in a network of community-based practices. Four main themes regarding GWA implementation emerged: benefits to clinical care, challenges in practice, CDS-specific issues, and physician-recommended improvements. Sub-themes included value in improving patient access to genetic services, inadequate time to discuss GWA recommendations, lack of patient follow-through with recommendations, and alert fatigue. While PCPs valued the GWA’s clinical utility, a number of challenges were identified in the administration and use of the GWA in practice. Based on participants’ recommendations, iterative changes have been made to the GWA and workflow to increase efficiency, upgrade the CDS process, and provide additional education to PCPs and patients. Future studies are needed to assess a diverse sample of physicians’ and patients’ perspectives on the utility of FHH screening utilizing EHR-based genomics recommendations.
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Acknowledgments
The authors acknowledge the contributions of the NorthShore Epic Optimization Team, in particular Darryck Maurer, for work on GWA development, implementation, and incorporation of suggested changes into the electronic version of the GWA. We especially thank the primary care physicians who took time out of their busy practices to participate in this study.
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Henry M. Dunnenberger has received consulting payments from Veritas. Amy A. Lemke, Jennifer Thompson, Peter J. Hulick, Annette W. Sereika, Christian Johnson, and Lauren Oshman declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
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Lemke, A.A., Thompson, J., Hulick, P.J. et al. Primary care physician experiences utilizing a family health history tool with electronic health record–integrated clinical decision support: an implementation process assessment. J Community Genet 11, 339–350 (2020). https://doi.org/10.1007/s12687-020-00454-8
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DOI: https://doi.org/10.1007/s12687-020-00454-8