With genetics becoming mainstream today, primary care has an opportunity to expand genetic counseling and testing to patients. Primary care providers play an important role in healthcare delivery. Often, until a person is diagnosed with a disease, they are the only provider the patient interacts with. For this reason, implementing genetic screening can make a great impact on patients.
According to Dr. Katrina Armstrong, Physician in Chief at Massachusetts General Hospital, "With the USPSTF (United States Preventative Task Force) reaffirming the importance of screening, counseling, and testing appropriate women for BRCA 1/2 mutations, primary care has both an opportunity and responsibility to lead in the implementation of these recommendations."
Today, many primary care providers are working to incorporate genetics into their practices, but are faced with many challenges:
- Changing guidelines
- Genetic specialist shortage
- Lack of reimbursement
- Limited time and knowledge
Since we understand these challenges can be daunting, this post outlines steps to expand primary care's role in genomics by educating clinicians, arming them with appropriate tools, and integrating with an electronic health record (EHR).
Educate and Engage Clinicians
Many primary care clinicians are uncomfortable discussing genetics with patients, which may lead to avoiding the topic of genomics altogether. Tricia See, a member of the cardiac and neurogenetics team at InformedDNA states," I saw a recent study that found that 23 percent of primary care physicians surveyed indicated discomfort discussing genetics with their patients. The comfort level is not there."
With the rise in genetic testing, the first step to expand primary care's role in genetic screening is to educate and engage clinicians by:
- Identifying clinicians who are interested
- Providing clinicians with training to discuss genetic information with patients
- Ensuring integration does not impact the normal workflow
To make your genetic screening population health effort successful, clinicians must be comfortable discussing genetics with patients.
Only after clinicians are comfortable discussing genetics with their patients can they expand their impact on genetics. The next step is fully optimizing your genetics workflow, with tools like CancerIQ.
Incorporate Tools to Streamline the Workflow
After clinicians are comfortable integrating genetics into the workflow, it's time to incorporate the tools needed for success. The easiest way to expand genetics in primary care is using digital risk assessment software. As mentioned in the recent Association of Cancer Executives webinar, many successful genetics programs have streamlined the genetics process using digital risk assessment software, like CancerIQ.
"The major challenge we have in primary care is figuring out how we integrate this information in a way that we are not adding a burden for physicians in their daily workflow, and at the same time capturing the date needed so we can give an optimal patient experience."
Arming Dr. Agarwal with a digital risk assessment tool has allowed OSF HealthCare to overcome this barrier. He states, "CancerIQ technology allows clinicians to identify, evaluate, and manage patients over time based on individual genetic risk factors, all within Epic's workflow." OSF healthcare is planning to roll out CancerIQ to all primary care locations in their system.
In addition, Lake Success Gastroenterology, a speciality practice at ProHEALTH Care Associates, a part of OptumCare, saw multiple benefits after implementing software into their workflow including:
- Individualized cancer screening
- Increase in the Detection Rate by 2.5 times
- Overcoming the time barrier associated with genetic screening
- Immediate access to genetic testing
After incorporating digital risk assessment software, 80 percent of patients interested in genetic testing followed through. Prior to implementation, only 16 percent of patients followed through.
California-based Adventist Health also saw improvements in identification of patients and a reduction in hereditary cancer related deaths after incorporating risk assessment software.
Dr. Candace Westgate, Medical Director with Adventist Health, said this about incorporating CancerIQ,
"I want to see this program in every single clinic within Adventist Health so that we can have a much bigger impact on cancer prevention for our patients."
Integrate With Your EHR
We recommend implementing digital risk assessment software prior to EHR integration to make the biggest impact right away, but understand integration is crucial to success.
Integration allows you to:
- Make cancer risk assessment part of the workflow
- Reduce the burden of multiple data points
- Gather proper family history health data EHR's struggle to gather
According to Dr. Alan Weiss, Chief Medical Officer with BayCare Health System, the goal of any EHR is to collect, display, and make data easier to find. An integration should do all of these things for you. In a recent post, we covered lessons learned when integrating genomics into your EHR including:
- Starting risk assessment without an EHR
- Knowing the right time to integrate
- Designing an interface clinical users will actually use
Integrating with your EHR is made easier through programs like the Cerner App Gallery and Epic App Orchard. At this time, we are actively working in both systems to make integration a seamless process.
While it's good to see primary care's role in genomics expand, there is still work to be done. Dr. Susanne Haga, Professor at the Duke University Center for Applied Genomics and Precision Medicine states,
"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."
Dr. Katrina Armstrong further adds, "Since the last UPSTF recommendations about preventing BRCA related cancers in 2013, progress in incorporating risk assessment, counseling, and testing into primary care has been slow"
Learn more on how Dr. Argarwal and OSF HealthCare are implementing digital risk assessment software in this case study.