Standards-Based Clinical Decision Support Platform to Manage Patients Who Meet Guideline-Based Criteria for Genetic Evaluation of Familial Cancer
Standards-Based Clinical Decision Support Platform to Manage Patients Who Meet Guideline-Based Criteria for Genetic Evaluation of Familial Cancer
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DOI：
10.1200/cci.19.00120
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发表时间：
2020-01-17
影响因子：
4.2
通讯作者：
Kawamoto, Kensaku
中科院分区：
文献类型：
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作者：
Del Fiol, Guilherme;Kohlmann, Wendy;Kawamoto, Kensaku
目的 电子健康记录 (EHR) 和家族健康史 (FHH) 数据的普遍采用为针对个人定制癌症筛查策略提供了机会。我们的目标是建立一个基于标准的临床决策支持 (CDS) 平台，用于识别和管理符合遗传性癌症遗传评估指南的患者。 方法 CDS 平台 (www.opencds.org) 用于实施基于 2018 年国家综合癌症网络遗传性乳腺癌/卵巢癌和结直肠癌遗传评估指南的算法。该平台旨在通过健康七级国际快速医疗互操作性资源标准与不同的 EHR 系统连接。该平台与 Epic EHR 集成，并在学术医疗保健系统的试点研究中进行了评估。 结果 CDS 平台针对 143,012 名患者的目标人群执行； 5,245 名 (3.7%) 符合基于 EHR 中记录的 FHH 的遗传评估标准。在一项临床试点研究中，遗传咨询师试图接触 71 名患者。在这些患者中，25 名患者 (35%) 预约了，10 名患者 (14%) 拒绝了，2 名患者 (3%) 不需要遗传咨询，7 名患者 (10%) 表示他们将来会考虑，还有 27 名患者 (38%) 无法联系到。迄今为止，13 名预定患者 (52%) 完成了就诊，其中 2 名 (15%) 被发现在癌症易感基因中存在致病性变异。 结论 与 EHR 系统集成的基于标准的 CDS 平台是一种很有前景的基于人群的方法，用于识别适合遗传性癌症遗传评估的患者。 (c) 2020 年美国临床肿瘤学会
PURPOSE The ubiquitous adoption of electronic health records (EHRs) with family health history (FHH) data provides opportunities for tailoring cancer screening strategies to individuals. We aimed to enable a standards-based clinical decision support (CDS) platform for identifying and managing patients who meet guidelines for genetic evaluation of hereditary cancer.METHODS The CDS platform (www.opencds.org) was used to implement algorithms based on the 2018 National Comprehensive Cancer Network guidelines for genetic evaluation of hereditary breast/ovarian and colorectal cancer. The platform was designed to be interfaced with different EHR systems via the Health Level Seven International Fast Healthcare Interoperability Resources standard. The platform was integrated with the Epic EHR and evaluated in a pilot study at an academic health care system.RESULTS The CDS platform was executed against a target population of 143,012 patients; 5,245 (3.7%) met criteria for genetic evaluation based on the FHH recorded in the EHR. In a clinical pilot study, genetic counselors attempted to reach out to 71 of the patients. Of those patients, 25 (35%) scheduled an appointment, 10 (14%) declined, 2 (3%) did not need genetic counseling, 7 (10%) said they would consider it in the future, and 27 (38%) were unreachable. To date, 13 (52%) of the scheduled patients completed visits, and 2 (15%) of those were found to have pathogenic variants in cancer predisposition genes.CONCLUSION A standards-based CDS platform integrated with EHR systems is a promising population-based approach to identify patients who are appropriate candidates for genetic evaluation of hereditary cancers. (c) 2020 by American Society of Clinical Oncology