Clinical genetics provider real-time workflow study

Abstract

Purpose: Our work is the first documentation, in real time, of workflow in a general genetics department including data on patient care, research, and other activities for both clinical geneticists and genetic counselors. Methods:All physician geneticists and genetic counselors in the medical genetics department used an electronic tool to record their activities in 15 minute increments during clinic hours, evenings, and weekends over a 10-week period.Results: The average work week was 54.1 hours for physicians and 43.5 hours for genetic counselors. During clinic hours physicians spent about one-fourth of their time on direct patient care, one-fourth on other patient-related activities, one-fourth on research unrelated to individual patient care, and the remaining fourth on all other activities. However, after hours and on weekends they spent most of their time on research. Genetic counselors spent half of their time on patient-related activities, one-fourth on direct patient care, and the remainder on all other activities. The total professional time averaged 7 hours per new patient and 3.5 hours per follow-up with nearly 60% of this time devoted to patient-related activities. Conclusions: The labor intensive nature of clinical genetics, the large amount of time devoted to patient-related activities, and continuing limitations on billing by genetic counselors all contribute to the financial challenges faced by genetics departments. Genet Med 2008:10(9):699 -706. Key Words: clinical genetics services, workforce, workflow, time study, reimbursement, genetic counselingProvision of medical genetics services is a time and labor intensive activity. 1,2 The detailed three generation pedigree not only takes far longer than the standard family history screening in primary care (which adds an average of only 3 min to a primary care visit 3 ), but frequently must be supplemented by acquisition and review of medical records of affected relatives, examination of parents and other relatives (who don't usually have their own appointments), and the review of family photographs when affected relatives are unavailable. Because of the complexity of modern genetic knowledge and the need to discuss implications for multiple family members, face-to-face genetic counseling is time-consuming. The ordering, insurance preauthorization, and follow-up of increasingly complex laboratory tests, literature review for rare diagnoses, and documentation of the visit (which is more extensive than in most disciplines due to the need to educate referring providers about rare disorders), as well as writing and reviewing of detailed summary letters for the family also contribute to the work of genetic counseling. Although some of these challenges exist in other fields, genetics remains unique in terms of dependence on family information. Furthermore, because most genetic disorders are rare, time savings through standardization of protocols, documentation tools, and patient education materials are rarely applicable. Rapid advances in genetic knowledge...

The time-consuming demands of the practice of medical genetics in the era of advanced genomic testing

“…[1][2][3][4][5][6][7] Some of these studies evaluated the time used by geneticists alone; others calculated the time required by the complete genetics team, including social workers, clinic coordinators, and secretaries. Also, several studies evaluated only face-toface activities, whereas others also looked into indirect patientrelated activities.…”

Identification of Genetic Counseling Service Delivery Models in Practice: A Report from the NSGC Service Delivery Model Task Force

“…The traditional in-person model of providing genetic counseling has been shown to involve an hour or longer of clinic visit time and several hours of case preparation, documentation of the genetic counseling provided, and followup (Wham et al 2010;McPherson et al 2008;Uhlmann et al 2009). This time intensive model is not well reimbursed by third party payers and is not practical to reach a large population (Tuckson 2006).…”

A Statewide Survey of Practitioners to Assess Knowledge and Clinical Practices Regarding Hereditary Breast and Ovarian Cancer

“…Given that access to genetics professionals is an independent predictor of physician referrals (Vig et al, 2009), our study highlights the need to actively recruit qualified genetics professionals to states such as Florida in order to enhance the delivery of these specialized services. However, a significant barrier to the provision of adequate genetic services is the low reimbursement rates, which can often result in these services costing more than the direct revenue they generate (McPherson et al, 2008;Tung, 2011); this needs to be addressed at a policy level. Hospital and Health Maintenance Organization administrators will also need to examine the benefit of hiring genetics professionals in terms of reducing the medical liability to their health-care providers and improving the quality of care for patients and families.…”