Formative Evaluation of Clinician Experience with Integrating Family History-Based Clinical Decision Support into Clinical Practice

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.

Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state‐of‐the‐science review

“…These tools generally allow patient self‐entry of the FH, and many provide clinical decision support directly to clinicians. Several have undergone a formal scientific assessment . Included in the online supporting information is an inventory of 15 tools that can be used for cancer FH collection/risk assessment as well as their attributes; it was developed in conjunction with the Global Alliance for Genomics and Health.…”

Clinical utility of a Web-enabled risk-assessment and clinical decision support program

“…2,3 Several computerized data-collection and risk-assessment programs have been developed to help combat these challenges. Examples include Health Heritage, 4 MyFamily, 5 Family Healthware, 6 HughesRiskApps, 7 and MeTree. 8 Studies of these and other nonelectronic risk-assessment aids have consistently shown the ability of such tools to increase the identification of individuals who meet guideline criteria for "increased" risk disease management strategies.…”

Integrating an EMR-based Transition Planning Tool for CYSHCN at a Children's Hospital: A Quality Improvement Project to Increase Provider Use and Satisfaction

“…Moreover, such programs have demonstrated efficacy in changing provider behaviors for numerous conditions and practice settings including: pediatric asthma diagnosis and treatment (Shiffman, Freudigman, Brandt, Liaw, & Navedo, 2000), adolescent cervical cancer screening (White & Kenton, 2013), and inpatient medication orders (Eslami, de Keizer, & Abu-Hanna, 2008). However, as with any change in practice, provider uptake and sustained use of these new technologies and tools remain a challenge (Carlfjord, Lindberg, Bendtsen, Nilsen, & Andersson, 2010; de Veer, Fleuren, Bekkema, & Francke, 2011; Doerr, Edelman, Gabitzsch, Eng, & Teng, 2014). …”