Evaluation of a Novel Electronic Genetic Screening and Clinical Decision Support Tool in Prenatal Clinical Settings

Abstract

"The Pregnancy and Health Profile" (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher's exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83% (513/618) of patients that provided feedback, 97% felt PHP was easy to use and 98% easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.

Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature

“…Patient-entered FH data, including the use of electronic risk assessment models, has been demonstrated to reduce the time required by healthcare professionals to collect information and has not resulted in poorer quality of data. 51,52 Point-of-care FH tools provide actionable clinical decision support for PCPs and have been developed for prenatal care, 53,54 family medicine, 55 and pediatrics. The exponential increase of genetic and genomic information is quickly exceeding the ability of humans to remember and process.…”

Implementation of an electronic genomic and family health history tool in primary prenatal care

“…The PHP was implemented into four clinical sites: (1) Mountain Area Health Education Center, an academic community‐based obstetrics and gynecology residency program in Asheville, NC; (2) Maine Dartmouth Family Medicine Residency Program, a rural academic family medicine program in Fairfield and Augusta, ME; (3) Montefiore Medical Group–Comprehensive Family Care Center, an urban federally qualified health center with an academic affiliation in the Bronx, NY; and (4) Clearvista Women's Care, Community Health Network, an obstetric practice that is part of a community hospital network in the suburbs of Indianapolis, IN. These sites were a convenience sample that were selected to provide geographic and demographic diversity [Edelman et al, ].…”

“…The goal of the PHP is to improve identification of women and babies at increased risk of genetic disease as well as other prenatal risk factors and to increase the rate at which these families are offered appropriate services and screening. Previous analysis demonstrated high patient satisfaction and usability regarding the PHP [Edelman et al, ]. Provider responses to PHP and the components and resources required for implementation have also been reported [Edelman et al, ].…”

“…Previous analysis demonstrated high patient satisfaction and usability regarding the PHP [Edelman et al, ]. Provider responses to PHP and the components and resources required for implementation have also been reported [Edelman et al, ].…”

“…The Pregnancy and Health Profile (PHP): A Screening and Risk Assessment Tool collects patient‐entered FHH, personal health history, and obstetric history. The system then performs risk assessment, and presents the provider with CDS during (or potentially prior to) the first clinical encounter [Edelman et al, ; Lin et al, ; NCHPEG, ]. The goal of the PHP is to improve identification of women and babies at increased risk of genetic disease as well as other prenatal risk factors and to increase the rate at which these families are offered appropriate services and screening.…”