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. 2023 Aug:7:e2300024.
doi: 10.1200/CCI.23.00024.

Development of an Electronic Health Record-Based Clinical Decision Support Tool for Patients With Lynch Syndrome

Kelsey S Lau-Min  1 , Joseph Bleznuck  2 , Colin Wollack  2 , Danielle B McKenna  3 , Jessica M Long  3 , Anna P Hubert  4 , Mariah Johnson  5 , Shavon E Rochester  3 , Gillain Constantino  6 , Christina Dudzik  6 , Abigail Doucette  7 , Kirk Wangensteen  8 , Susan M Domchek  3   9 , Jeffrey Landgraf  2 , Jessica Chen  2 , Katherine L Nathanson  4   9 , Bryson W Katona  6
Affiliations

Development of an Electronic Health Record-Based Clinical Decision Support Tool for Patients With Lynch Syndrome

Kelsey S Lau-Min et al. JCO Clin Cancer Inform. 2023 Aug.

Abstract

Purpose: To develop an electronic health record (EHR)-based clinical decision support (CDS) tool to promote guideline-recommended cancer risk management among patients with Lynch syndrome (LS), an inherited cancer syndrome that confers an increased risk of colorectal and other cancer types.

Materials and methods: We conducted a cross-sectional study to determine the baseline prevalence and predictors of guideline-recommended colonic surveillance and annual genetics program visits among patients with LS. Multivariable log-binomial regressions estimated prevalence ratios (PRs) of cancer risk management adherence by baseline sociodemographic and clinical characteristics. These analyses provided rationale for the development of an EHR-based CDS tool to support patients and clinicians with LS-related endoscopic surveillance and annual genetics program visits. The CDS leverages an EHR platform linking discrete genetic data to LS Genomic Indicators, in turn driving downstream clinician- and patient-facing CDS.

Results: Among 323 patients with LS, cross-sectional adherence to colonic surveillance and annual genetics program visits was 69.3% and 55.4%, respectively. Patients with recent electronic patient portal use were more likely to be adherent to colonic surveillance (PR, 1.67; 95% CI, 1.11 to 2.52). Patients more recently diagnosed with LS were more likely to be adherent to annual genetics program visits (PR, 0.58; 95% CI, 0.44 to 0.76 for 2-4 years; PR, 0.62; 95% CI, 0.51 to 0.75 for ≥4 compared with <2 years). Our EHR-based CDS tool is now active for 421 patients with LS throughout our health system.

Conclusion: We have successfully developed an EHR-based CDS tool to promote guideline-recommended cancer risk management among patients with LS.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/cci/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Kelsey S. Lau-Min

Employment: GlaxoSmithKline

Stock and Other Ownership Interests: GlaxoSmithKline

Joseph Bleznuck

Employment: Penn Medicine

Jessica M. Long

Employment: DePuy Companies

Stock and Other Ownership Interests: DePuy Companies

Anna P. Hubert

Employment: NAMSA

Mariah Johnson

Employment: Philips Pharma Solutions

Shavon E. Rochester

Stock and Other Ownership Interests: Zomedica

Research Funding: Sutro Biopharma (Inst), AstraZeneca (Inst), Novita Pharmaceuticals (Inst), Alkermes (Inst), Xencor (Inst), Verismo Therapeutics (Inst), Shattuck Labs (Inst), K-Group Beta (Inst), Clovis Oncology (Inst), NRG Oncology (Inst)

Abigail Doucette

Employment: Children's Hospital of Philadelphia

Kirk Wangensteen

Research Funding: Calico, LLC

Open Payments Link: https://openpaymentsdata.cms.gov/physician/1959958

Susan M. Domchek

Honoraria: AstraZeneca, GlaxoSmithKline

Research Funding: AstraZeneca (Inst), Clovis Oncology (Inst)

Open Payments Link: https://openpaymentsdata.cms.gov/physician/917904

Jeffrey Landgraf

Employment: Emory Healthcare

Leadership: Emory Healthcare

Travel, Accommodations, Expenses: Emory Healthcare

Jessica Chen

Employment: University of Pennsylvania

Katherine L. Nathanson

Consulting or Advisory Role: Merck

Bryson W. Katona

Other Relationship: Janssen, Immunovia, Epigenomics, Guardant Health, Freenome, Universal Diagnostics, Recusion

Uncompensated Relationships: InVitae, Ambry Genetics, GenDx, Myriad Genetics

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Clinician-facing, patient-level clinical decision support for Lynch syndrome. Printed with permission from Epic Systems Corporation, Verona, WI.
FIG 2.
FIG 2.
Clinician-facing, population-level clinical decision support for Lynch syndrome. Printed with permission from Epic Systems Corporation, Verona, WI.
FIG 3.
FIG 3.
Patient-facing clinical decision support for Lynch syndrome. Printed with permission from Epic Systems Corporation, Verona, WI.
FIG A1.
FIG A1.
Spline regression of the prevalence of annual genetics program visits by time since initial Lynch syndrome diagnosis in years. Dashed lines = 95% CI.
See this image and copyright information in PMC

References

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