Electronic health record interventions at the point of care improve documentation of care processes and decrease orders for genetic tests commonly ordered by nongeneticists

Scheuner, Maren T.; Peredo, Jane; Tangney, Kelly; Schoeff, Diane; Sale, Taylor J.; Lubick-Goldzweig, Caroline; Hamilton, Alison B.; Hilborne, Lee H.; Lee, Martin; Mittman, Brian; Yano, Elizabeth M.; Lubin, Ira M.

doi:10.1038/gim.2016.73

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…13 Our approach also differs from decision support that requires clinicians to document the indication for testing at order entry. 4 Documentation requirements can lead to ''pop-up button fatigue.'' By design, no additional pathology intervention would be required because the laboratory cutoff for further testing has already been evaluated and established in our patients.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 At health care institutions with informatics resources, computerized order entry provides an opportunity to apply CPGs within a unique health care system based on the target patient population and institutional culture and resources. 4 Pathologists have specialized training in both clinical medicine and laboratory sciences and can drive multidisciplinary efforts to understand the limitations of CPGs and develop interventions that promote better patient care. Our team undertook a project to compare international practice guidelines with current ordering practices within our organization.…”

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confidence: 99%

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A Novel Approach to Improving Utilization of Laboratory Testing

Zhou¹,

Procop²,

Riley³

2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing.Objective.-To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population.Design.-We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P , .001).Results.-Our ''one-button'' order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis.Conclusions.-Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A Novel Approach to Improving Utilization of Laboratory Testing

Zhou¹,

Procop²,

Riley³

2017

Archives of Pathology &Amp; Laboratory Medicine

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“…These errors can contribute to under-use, overuse, or misuse of genetic testing that can compromise the quality of patient care. 27,28 With this in mind, thought must be given at the health care system level to develop effective strategies to deliver genetic services to patients. These strategies must address workforce capacity, organizational structure, and education.…”

Section: Germline Genetic Testing Challengesmentioning

confidence: 99%

“…Under the new approach, nongeneticists can be assisted by decision support tools in the EHR that help with assessing family history risk, identifying indications for genetic testing, and suggesting management options based on genetic test results. [41][42][43] The VA National Precision Oncology Program (NPOP) is shaped by a commitment to be a high reliability organization (HRO). As such, the goal is to create a system of excellence that integrates precision medicine, implementation science, and the learning health care system to improve the health and health care of veterans with cancer.…”

Section: Workforce Capacitymentioning

confidence: 99%

Integrating Germline Genetics Into Precision Oncology Practice in the Veterans Health Administration: Challenges and Opportunities

Scheuner¹

2020

Federal Practitioner

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The advent of germline testing as a standard-ofcare practice for certain tumor types and patients presents unique opportunities and challenges for the field of precision oncology. This article describes strategies to address workforce capacity, organizational structure, and genetics education needs within the US Department of Veterans Affairs (VA) with the expectation that these approaches may be applicable to other health care systems. Observations: Germline information can have health, reproductive, and psychosocial implications for veterans and their family members, which can pose challenges when delivering germline information in the setting of cancer care. Additional challenges include the complexity inherent in the interpretation of germline information, the national shortage of genetics professionals, limited awareness and knowledge about genetic principles among many clinicians, and organizational barriers, such as the inability to order genetic tests and receive results in the electronic health record. These challenges demand thoughtful implementation planning at the health care system level to develop sustainable strategies for the delivery of high-quality genetic services in precision oncology practice. Conclusions: The VA is uniquely positioned to address the integration of germline genetic testing into precision oncology practice due to its outsized role in treating veterans with cancer, training the health care workforce, and developing, testing, and implementing innovative models of clinical care.

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“…13 A third described the use of electronic health record interventions at the point of care to improve documentation of care processes. 14…”

Section: Genomics and Core Public Health Functions And Servicesmentioning

confidence: 99%

From public health genomics to precision public health: a 20-year journey

Khoury

Bowen

Clyne

et al. 2018

Genetics in Medicine

122

109

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In this paper, we review the evolution of the field of public health genomics in the United States in the past two decades. Public health genomics focuses on effective and responsible translation of genomic science into population health benefits. We discuss the relationship of the field to the core public health functions and essential services, review its evidentiary foundation, and provide examples of current US public health priorities and applications. We cite examples of publications to illustrate how Genetics in Medicine reflected the evolution of the field. We also reflect on how public-health genomics is contributing to the emergence of "precision public health" with near-term opportunities offered by the US Precision Medicine (AllofUs) Initiative.

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Electronic health record interventions at the point of care improve documentation of care processes and decrease orders for genetic tests commonly ordered by nongeneticists

Abstract: EHR point-of-care tools improved documentation of genetic testing processes and decreased utilization of genetic tests commonly ordered by nongeneticists.Genet Med 19 1, 112-120.

Cited by 7 publications

References 34 publications

A Novel Approach to Improving Utilization of Laboratory Testing

A Novel Approach to Improving Utilization of Laboratory Testing

Integrating Germline Genetics Into Precision Oncology Practice in the Veterans Health Administration: Challenges and Opportunities

From public health genomics to precision public health: a 20-year journey

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