Expanding Primary Care’s Role in Genetic Screening

Thursday, December 5, 2019

EHR Family Health History Tools

One of the keys to genetic screening efforts is to get good family health history data in the electronic health record (EHR) as structured data, although EHRs typically haven’t had good tools for taking family histories. In North Carolina, the Duke Center for Applied Genomics and Precision Medicine created MeTree, a patient-facing web-based family and personal health history collection and clinical decision support program. It collects personal history on diet, exercise, smoking, and clinical data to calculate the Gail, BRCApro, and Framingham scores in addition to personal and family health history on 20 cancers, 14 hereditary cancer and cardiovascular syndromes, and 21 other conditions.

Traditionally patients had to fill out paper forms about their family’s health history. “That is of limited value to physicians,” says Susanne Haga, Ph.D., a professor and researcher in the Duke Center for Applied Genomics and Precision Medicine. “They need something so that the data can be processed with evidence-based guidelines. As soon as the patient completes the MeTree family history intake, the physician gets a list of recommendations based on that information right then and there and can share it with the patient during a visit.”

A pilot study of MeTree in two community-based primary care clinics at Cone Health in Greensboro, N.C., showed that MeTree could be adopted into primary care practices without disruption to workflow, was useful to patients and providers, and found that a high number of primary care patients (44 percent) were at high risk for one of the pilot clinical decision support conditions (breast cancer, ovarian cancer, colon cancer, hereditary cancer syndromes or thrombosis.)

Haga says the use of this type of family health history tool is starting to migrate from major academic medical centers into regional and smaller healthcare systems. “There are multiple benefits,” she adds. “It reduces paperwork and improves input, and does the analysis for the physician.” Primary care should be more of a point person, Haga notes. “Once it is clear that a patient needs to seek care from a specialist or genetic counselor, primary care will facilitate and direct them where they need to go. But we are not there yet.”

Excerpt from HealthCare Innovation. Read full article.