The proposed collaborative project assesses the feasibility of integrating a new software module designed to collect, interpret, and manage family history into electronic health record (EHR) systems in a manner that is useful and acceptable to primary care providers and patients. The final product to be developed will be a commercially viable software module capable of systematically acquiring, interpreting and reporting a patient's family history in a primary care setting. Currently, there is no family history evaluation tool that is either systematically implemented in primary care settings or integrated into existing EHR systems. Phase I will focus on hereditary breast and ovarian cancer syndrome (HBOC) in women 21 to 55 years of age. The research institution (Women & Infants Hospital, Rhode Island) has developed a family history protocol for identifying individuals with evidence of hereditary breast/ovarian cancer based on combining existing professional guidelines. This protocol will be the basis of the first software module to be developed by the small business concern (Primetime Medical Software). This module will then be integrated into a selected EHR system (TouchWorks by Allscripts Healthcare Solutions). The TouchWorksTM EMR system is currently used by the Maine-Dartmouth Family Practice residency training program (MDFP), which will test the HBOC module for one month as part of routine practice. A stand alone version of this family history module (not integrated with EHR) will be tested at a second clinical site, Memorial Hospital of Rhode Island Family Care Center. The specific aims of this Phase I project are to: 1) develop and validate the HBOC family history software module, 2) integrate this module within a selected EHR system, 3) use the embedded module in a primary care clinical setting using EHR, 4) identify other disorders in which family history might be useful as targets for future modules, 5) identify and gain agreements from two other EHR system manufacturers to include HBOC and future modules in their EHR (in Phase II), and 6) identify and gain agreements from two other clinical practice sites to use these embedded modules (in Phase II). Primetime currently has interoperability agreements with 46 EHR manufacturers for computerized capture of patient history, representing over 90% of the EHR systems installed in physicians' offices. The recent advent of national initiatives to promote both EHR systems and family history in preventive medicine provides an unprecedented opportunity for their integration. Family history has been shown to aid in the risk assessment for a variety of health concerns. Integration of a software module designed to collect, interpret, and manage family history with an EHR has important public health implications, since hundreds of thousands of physicians will have access to this module.
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