Method in Action

 Using an electronic patient questionnaire to collect cancer family history

patient screening workflowFigure 3. Workflow with patient-entered family history collection in the waiting room and provider risk assessment using an electronic tool. CRA = cancer risk assessment. FH = family history. EHR = Electronic Health Record.

University Women’s Care is an obstetric and women’s health practice affiliated with an academic teaching hospital in an urban setting. Staff include attending physicians, nurse practitioners, and nurses. OBGYN residents and medical and nursing students participate in rotations. After an initial pilot project with the medical genetics department, the practice adopted a family history collection approach that is based on an electronic collection and risk assessment tool.

New patients are asked to arrive 15 minutes early to their appointment to check in and fill out paperwork. This includes completing a short electronic questionnaire on a tablet computer in the waiting room. The questionnaire collects information about the family history of cancer. When the patient is done, the questionnaire data is automatically run through the tool database to perform cancer risk assessment and a report is generated and imported into the EHR.

During the clinical encounter, the provider reviews the risk assessment results and clarifies family history information with the patient as needed. Using the risk assessment results, the provider and patient discuss red flags in the family history and next steps, which can include a recommendation for cancer screening and/or a referral for genetic counseling and further evaluation. The provider documents the encounter and any referrals in the EHR.

This example was adapted from published reports and commercial tools, such as CRA Health, Family Healthware, MyLegacy, and Progeny. See the Family History Features Worksheet for additional family history tools.