title: Comparing electronic health record portals to obtain patient-entered family health history in primary care.
abstract: BACKGROUND
  There is growing interest in developing systems to overcome barriers for acquiring and interpreting family health histories in primary care.
  
  
  OBJECTIVE
  To examine the capacity of three different electronic portals to collect family history from patients and deposit valid data in an electronic health record (EHR).
  
  
  METHODS
  Pilot trial.
  Patients were enrolled from four primary care practices and were asked to collect family health history before a physical exam using either telephone-based interactive voice response (IVR) technology, a secure Internet portal, or a waiting room laptop computer, with portal assigned by practice. Intervention practices were compared to a "usual care" practice, where there was no standard workflow to document family history (663 participants in the three intervention arms were compared to 296 participants from the control practice).
  
  
  METHODS
  New documentation of any family history in a coded EHR field within 30 days of the visit. Secondary outcomes included participation rates and validity.
  
  
  RESULTS
  Demographics varied by clinic. Documentation of new family history data was significantly higher, but modest, in each of the three intervention clinics (7.5 % for IVR clinic, 20.3 % for laptop clinic, and 23.1 % for patient portal clinic) versus the control clinic (1.7 %). Patient-entered data on common conditions in first degree relatives was confirmed as valid by a genetic counselor for the majority of cases (ranging from 64 to 82 % in the different arms).
  
  
  CONCLUSIONS
  Within primary care practices, valid patient entered family health history data can be obtained electronically at higher rates than a standard of care that depends on provider-entered data. Further research is needed to determine how best to match different portals to individual patient preference, how the tools can best be integrated with provider workflow, and to assess how they impact the use of screening and prevention.
authors.affiliation: Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murray
authors.forename: Monica A
authors.initials: MA
authors.lastname: Giovanni
authors.forename: Elissa
authors.initials: E
authors.lastname: Klinger
authors.forename: Elise
authors.initials: E
authors.lastname: George
authors.forename: Lucas
authors.initials: L
authors.lastname: Marinacci
authors.forename: George
authors.initials: G
authors.lastname: Getty
authors.forename: Phyllis
authors.initials: P
authors.lastname: Brawarsky
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rocha
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D057286:Electronic Health Records / Q000592:standards* / Q000639:trends; D005192:Family Health / Q000592:standards* / Q000639:trends; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000639:trends; D010865:Pilot Projects; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D015203:Reproducibility of Results