Health Information Technology Enhanced Family Health History Documentation & Management in Primary Care

Family health history and an individual’s lifestyle are known contributors to risk of developing chronic diseases such as diabetes, heart disease, and cancer. Assessing this information in a systematic way may facilitate early identification of patients at greatest risk, and promote informed decisionmaking by patients and communication with their health care providers. Effective use of health risk appraisals (HRAs) by patients in primary care settings may promote accurate risk assessment, motivate health promotion and behavior change, and facilitate population management.

The widespread deployment and meaningful use of electronic health records (EHRs) offers an opportunity to systematically integrate HRAs with EHRs with the ability to create customized decision support and recommendations for primary prevention and screening. This project reported on Patient Risk Evaluation and Prevention (PREP), a study which systematically collected family health history and lifestyle risk factors from primary care patients, and produced a personalized HRA.

The specific aims of the project were as follow:

• To develop a patient-reported, EHR-integrated, personalized risk assessment module to provide tailored disease risk and risk reduction information for these four common conditions for the patient and their primary care physician. 
• To measure the reach and effectiveness of this integrated risk assessment module by conducting a cluster randomized controlled trial (RCT) of adult primary care patients in the Brigham and Women’s Primary Care Practice-Based Research Network. 
• To evaluate facilitators and barriers to the adoption and implementation. 

PREP was a pragmatic cluster RCT where pre-visit intervention patients completed an assessment of their family history, lifestyle, and risk perception, and received a personalized HRA to discuss with their doctor. Post-visit, intervention patients received an assessment that included just the risk perception questions to re-assess accuracy of self-perceived risk. The same information was collected from the control patients but in the reverse order so that no information was available for the visit.

Results from the study found that pre-visit use of a multi-condition EHR-integrated HRA in primary care has the potential to modestly improve patient-provider communication about risk and changes that can be made to improve health. Patient understanding of personal health risks were also improved by linking patient-provided information with the health care team and providing personalized education, reminders, and health tips.