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Deploying Clinical Decision Support for Familial Hypercholesterolemia.

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|January 16, 2023
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Summary

Familial hypercholesterolemia (FH) is underdiagnosed, but clinical decision support (CDS) tools can improve detection. This study details the development and implementation of a genomic CDS for FH, highlighting challenges and lessons learned for broader genomic medicine integration.

Keywords:
clinical decision supportfacilitators and barriershuman–computer interactionimplementation and deploymentinterfaces and usabilityprecision medicinetesting and evaluationworkflows and human interactions

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Area of Science:

  • Genomic Medicine
  • Cardiovascular Genetics
  • Health Informatics

Background:

  • Familial hypercholesterolemia (FH) is a common genetic disorder significantly increasing coronary heart disease risk.
  • Despite its prevalence, FH remains substantially underdiagnosed in clinical practice.
  • Clinical decision support (CDS) tools offer a promising avenue for enhancing FH identification.

Purpose of the Study:

  • To describe the development and implementation of a genomic CDS tool for FH detection.
  • To share insights and lessons learned from integrating CDS into an academic medical center's workflow.
  • To identify challenges encountered during the CDS development and EHR integration process.

Main Methods:

  • A four-phase approach was employed: algorithm development/validation, institutional approvals, prototype development, and implementation science evaluation.
  • Extensive stakeholder engagement, including healthcare providers, occurred throughout the 4-year development period.
  • An implementation science framework guided the evaluation of the CDS.

Main Results:

  • The project spanned approximately 4 years, involving 15 stakeholder groups.
  • Six primary challenges were identified during CDS implementation: committee approvals, knowledge resource alignment, workflow adaptation, lack of guidelines, EHR transition, and EHR limitations for genomic medicine.
  • Feedback from healthcare providers was integrated at each development stage.

Conclusions:

  • Developing and implementing genomic CDS for FH presents multifaceted challenges across various domains.
  • Lessons learned from this experience can inform and streamline future CDS development and deployment for genomic medicine.
  • Effective integration of CDS requires careful consideration of institutional factors and EHR capabilities.