![]() The current generation of electronic health record (EHR) systems is not well equipped for genomic medicine implementation instead of increasing provider efficiency and simplifying clinical workflows, EHRs add to provider cognitive burden. The uptake of cascade testing for FH is also low and approximately 90% of individuals with FH in the United States remain undiagnosed. FH, the most prevalent of these conditions, continues to have poor awareness, detection, and control. Tier 1 genomic disorders including familial hypercholesterolemia (FH), Lynch syndrome, and hereditary breast and ovarian cancer syndromes affect approximately 1 in 100 individuals in the United States. The lessons learned herein may be helpful in streamlining the development and deployment of CDS to facilitate genomic medicine implementation. During CDS implementation six main challenges were identified: (1) need for multiple institutional committee approvals (2) need to align the CDS with institutional knowledge resources (3) need to adapt the CDS to differing workflows (4) lack of institutional guidelines for CDS implementation (5) transition to a new institutional electronic health record (EHR) system and (6) limitations of the EHR related to genomic medicine.Ĭonclusion We identified multiple challenges in different domains while developing CDS for FH and integrating it with the EHR. During this 4-year period, we engaged with 15 stakeholder groups to build and integrate the CDS, including health care providers who gave feedback at each stage of development. Results The timeline for this work was approximately 4 years algorithm development and validation occurred from August 2018 to February 2020. Methods CDS development and implementation were conducted in four phases: (1) development and validation of an algorithm to identify “possible FH” (2) obtaining approvals from institutional committees to develop the CDS (3) development of the initial prototype and (4) use of an implementation science framework to evaluate the CDS. We describe our experience in the development and implementation of a genomic CDS for FH at a large academic medical center. Clinical decision support (CDS) tools have the potential to increase FH detection. Objective Familial hypercholesterolemia (FH), a prevalent genomic disorder that increases risk of coronary heart disease, remains significantly underdiagnosed. ![]() An Implementation Science Framework to Evaluate CDS.Development and Validation of a Phenotyping Algorithm to Trigger CDS.Als PDF herunterladen Lizenzen und Reprints
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