title: Electronic health record interventions at the point of care improve documentation of care processes and decrease orders for genetic tests commonly ordered by nongeneticists.
abstract: To determine whether electronic health record (EHR) tools improve documentation of pre- and postanalytic care processes for genetic tests ordered by nongeneticists.
  
  
  
  We conducted a nonrandomized, controlled, pre-/postintervention study of EHR point-of-care tools (informational messages and template report) for three genetic tests. Chart review assessed documentation of genetic testing processes of care, with points assigned for each documented item. Multiple linear and logistic regressions assessed factors associated with documentation.
  
  
  
  Preimplementation, there were no significant site differences (P > 0.05). Postimplementation, mean documentation scores increased (5.9 (2.1) vs. 5.0 (2.2); P = 0.0001) and records with clinically meaningful documentation increased (score >5: 59 vs. 47%; P = 0.02) at the intervention versus the control site. Pre- and postimplementation, a score >5 was positively associated with abnormal test results (OR = 4.0; 95% CI: 1.8-9.2) and trainee provider (OR = 2.3; 95% CI: 1.2-4.6). Postimplementation, a score >5 was also positively associated with intervention site (OR = 2.3; 95% CI: 1.1-5.1) and specialty clinic (OR = 2.0; 95% CI: 1.1-3.6). There were also significantly fewer tests ordered after implementation (264/100,000 vs. 204/100,000; P = 0.03), with no significant change at the control site (280/100,000 vs. 257/100,000; P = 0.50).
  
  
  
  EHR point-of-care tools improved documentation of genetic testing processes and decreased utilization of genetic tests commonly ordered by nongeneticists.Genet Med 19 1, 112-120.
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Maren T
authors.identifier: 0000-0002-9105-1369
authors.initials: MT
authors.lastname: Scheuner
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Peredo
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Kelly
authors.identifier: 0000-0002-2612-6213
authors.initials: K
authors.lastname: Tangney
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Schoeff
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Taylor
authors.initials: T
authors.lastname: Sale
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Caroline
authors.identifier: 0000-0001-7768-0188
authors.initials: C
authors.lastname: Lubick-Goldzweig
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Hamilton
authors.affiliation: Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.|Quest Diagnostics, Madison, New Jersey, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Hilborne
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Mittman
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Lubin
mesh_terms: D004282:Documentation; D057286:Electronic Health Records; D005165:Factor V / Q000235:genetics*; D005260:Female; D005820:Genetic Testing / Q000379:methods* / Q000592:standards; D015796:HLA-B27 Antigen / Q000235:genetics*; D000071020:Hemochromatosis Protein / Q000235:genetics*; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems
chemical_list: C103673:HFE protein, human; D015796:HLA-B27 Antigen; D000071020:Hemochromatosis Protein; C095381:factor V Leiden; D005165:Factor V