Genetic Counseling Referral Alert Failed to Catch On

By Leah Lawrence - Last Updated: August 3, 2022

Results of a recent study suggested that despite interest in an automated tool for referrals to genetic counseling and testing for patients at high-risk for hereditary cancer syndromes, there are significant obstacles to acceptance of a new alert.

Researchers designed an automated alert to help increase appropriate referrals for cancer genetic counseling. They piloted this alert, known as Best Practice Advisory (BPA), in Epic, to notify oncology providers when a patient had a personal or family history that merited referral to cancer genetics.

Because Epic could not gather the complex clinical data unassisted, a medical assistant or registered nurse had to complete questionnaires to assess the need for referral.

“Five main questions were required (unless a previous main question’s answer was positive) related to the patient having (1) breast cancer, (2) colon cancer, (3) endometrial cancer, (4) selected rare cancers, or (5) any other reason for genetic assessment,” the researchers explained. “Sub-questionnaires for breast, colon, or endometrial cancer opened if their main question was answered positively. If any answer suggested increased inherited cancer risk, a referral BPA alerted, suggesting a genetics referral order.”

The study showed that initial interaction with the alert was high, but rapidly decreased. The questionnaire was completed in only 7.2% of more than 32,000 interactions and in 14.9% of patients over a 9-month period. Of the completed questionnaires, 80.6% were completed at the first alert; 12.1% at the second alert and 3.3% after the third alert.

Before the BPA was implemented, there were 245 genetic referral orders compared with 480 after it was implemented; however, only 89 of the 480 were from the BPA.

“Overwhelmingly, though, the most common response to the questionnaire BPA was dismissal,” the researchers wrote. “Stakeholder interviews suggest that despite interest in the BPA’s purpose, uptake was limited by a belief that it was not a clinic priority, competed with other required BPAs, and unacceptably slowed the rooming process.”


Can Automated Alerts in the Electronic Health Record Encourage Referrals for Genetic Counseling and Testing Among Patients at High Risk for Hereditary Cancer Syndromes?