American Society for Automation in Pharmacy January 25, 2013
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1 American Society for Automation in Pharmacy January 25, 2013 Presentation by W. Gregory Feero, M.D., Ph.D. Maine Dartmouth Family Medicine Residency Contributing editor, Journal of the American Medical Association
2 Disclosures No financial or intellectual conflicts of interest. I am a primary care doctor. For better or worse, my opinions are my own. No endorsements, in either direction.
3 Outline Family history still in style! A means to an end? A historical incentive.
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5 Top 10 Causes of Death Diseases of heart 2. Cancer 3. Chronic lower respiratory diseases 4. Stroke 5. Accidents (unintentional injuries)* 6. Alzheimer s disease 7. Diabetes mellitus 8. Influenza and pneumonia* 9. Kidney disease 10. Intentional self harm CDC 2012
6 Family History Mother, father, brother, sister, child affected: Type 2 diabetes 2-6X risk increase Hypertension 2-3X risk increase Coronary heart disease 2X risk increase
7 Family history is still the cheapest, most accessible, most time-tested way to get a rough estimate of the genetic component of disease risk.* *plus a bit of the environmental risk
8 Numerous guidelines for screening, testing, and management of a wide variety of disorders are modified by a positive family history e.g. USPSTF AHA pre-athletic physical, ADHD rx ADA DM II screening ACOG prenatal care guidelines etc.
9 Do health professionals routinely take a good family history? NO!* *current company excepted.
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11 Family health history in the genomic era? You better believe it!!!
12 Impact of Common Genetic Variants and FHx on Colorectal Cancer Risk (>42K individuals) Absolute 10 yrs risk Population Risk Age Dunlop et al., Gut. (2012)
13 Impact of Common Genetic Variants and FHx on Colorectal Cancer Risk (>42K individuals) Absolute 10 yrs risk Age FH+ Population Risk Dunlop et al., Gut. (2012)
14 Impact of Common Genetic Variants and FHx on Colorectal Cancer Risk (>42K individuals) Absolute 10 yrs risk Age >13 alleles FH+ Population Risk Dunlop et al., Gut. (2012)
15 Impact of Common Genetic Variants and FHx on Colorectal Cancer Risk (>42K individuals) Absolute 10 yrs risk Age >13 alleles, FH+ >13 alleles FH+ Population Risk Dunlop et al., Gut. (2012)
16 Impact of Common Genetic Variants and FHx on Colorectal Cancer Risk (>42K individuals) Absolute 10 yrs risk Age >13 alleles, FH+ >14 alleles >13 alleles FH+ Population Risk Dunlop et al., Gut. (2012)
17 Impact of Common Genetic Variants and FHx on Colorectal Cancer Risk (>42K individuals) 0.5 >14 alleles, FH+ 0.4 Absolute 10 yrs risk Age >13 alleles, FH+ >14 alleles >13 alleles FH+ Population Risk Dunlop et al., Gut. (2012)
18 Family health history and the pharmacist. Statin therapy for CAD.
19 Increase in Identification of High CVD Risk by Routine vs. Structured FHx Assessment Routine Assessment Without FHx Info With FHx Info High CVD Risk = 10 yr risk > 20% Qureshi et al., Ann Intern Med. (2012)
20 Increase in Identification of High CVD Risk by Routine vs. Structured FHx Assessment Routine Assessment Structured Assessment +0.5% +5.1% { Count me a skeptic when it comes to genetic technologies in primary care practice. How nice to be shown that I might be wrong. Without FHx Info Berg, Ann Intern Med. (2012) With FHx Info Without FHx Info With FHx Info High CVD Risk = 10 yr risk > 20% Qureshi et al., Ann Intern Med. (2012)
21 Questions for the crowd. Could collection of FHH in pharmacist practice settings improve patient outcomes? How? What systems exist for FHH collection, storage, and sharing (interpretation)? Should they exist? Could these be made interoperable with PHR/ EHRs?
22 ContentDisplay.cfm? ContentFileID=7960&MicrositeID=0&Fuse Preview=Yes
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26 August 24-26, 2009
27 Health Information Technology and Family Health History More efficient data collection Risk stratification by expert system Point of care patient/physician education Tracking and integration with other health care
28 U.S. Surgeon General s Family Health History Initiative In 2004, the Surgeon General introduced the first version of the web-based tool, My Family Health Portrait. This tool helped consumers by enabling them to complete histories at home. However the original tool was NOT standards-based, interoperable, or EHR-ready.
29 Indian Health Service Sponsoring Federal Agencies National Human Genome Research Institute National Cancer Institute Agency for Healthcare Research and Quality National Institute of Diabetes and Digestive and Kidney Disorders Office of Rare Diseases, National Institutes of Health Substance Abuse and Mental Health Services Administration National Office of Public Health Genomics, Centers for Disease Control and Prevention Office of the National Coordinator for Health Information Technology Office of Minority Health Office of the Surgeon General Office of the Assistant Secretary for Planning and Evaluation Federal Health Architecture (Veterans Health Administration and Department of Defense)
30 My Family Health Portrait: Now an interoperable tool In January 2009, the Surgeon General launched a new family health history tool. This version of MFHP is tool is standards-based, interoperable and PHR/EHR-ready. Consumers can share histories electronically with other family members and doctors.
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33 Standards-based XML-output HL7 family history model LOINC SNOMED-CT HL7 Vocabulary Minimum core data set (AHIC/ HITSP)* *Feero W.G. et al JAMIA, 2008
34 Demonstrated interoperability First connectivity partner to enter a cooperative agreement with the Office of the Surgeon General is Microsoft HealthVault. This collaboration offers: Consumer control of personal information Seamless connection to HealthVault affiliates
35 My Family Health Portrait Structured Data + Connec8vity = Interoperability My Family Health Portrait Family Members Care Providers Structured Data HealthVault Affiliates Save to Partners
36 Family Health History Surgeon General's My Family Health Portrait 36
37 Free, openly-available source code The Surgeon General s tool is openly-available for other organizations to adopt. Source code for the tool is available without charge. No attribution to Surgeon General is needed. The adopted tool must preserve interoperability features, and no endorsement by the government can be implied.
38 The existence of ample evidence, standards, and a good tool does not NEWS FLASH!!!! guarantee translation to practice. - education - performance improvement - incentives** - penalties
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41 Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information
42 EHR incentives and MU 2009 ARRA funded Started in 2011 Staged adoption 2 year intervals
43 EHR incentives and MU Core and Menu objective to meet goals EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf September 2012 Stage 2 final rule published Family health history one of 6 menu criteria
44 Family health history and MU
45 Signs of movement in the HIT universe!
46 Conclusions Family health history is very much a tool for the genomic era The intersection of HIT and family history is rapidly expanding Pharmacists could play a key role in ensuring the effective (meaningful?) use of FHH
47 THANKS! Some slides courtesy of: Greg Downing, Office of the Secretary, DHHS Anastasia Wise, The National Human Genome Research Institute, NIH
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