Development, Implementation and Initial Results of CDSS Recommendations for Patients at Risk of Hereditary Breast Cancer

Abstract

Breast cancer represents 23% of all cancers diagnosed among women each year. BRCA1 and BRCA2 are tumor suppressor genes related to the most frequent form of hereditary breast and ovarian cancer, as well as other types of cancer. The aim of this work is to describe the development of Clinical Decision Support Systems (CDSS) for referral to genetic counseling in patients at increased risk of pathogenic variants in BRCA1 and BRCA2, and to describe results during the pilot study implementation (from January 5, 2021 to March 5, 2021). To achieve integration and system interoperability, we used FHIR and CDS-Hooks within the CDSS development. A total of 142 alerts were triggered by the system for 72 physicians in 98 patients. Results showed an acceptance rate for the recommendation of 2.1%, which could improve using intrusive alerts in all of the hooks.