A revised high-tech tool from the Department of Health and Human Services might make filling out a pre-exam checklist in the doctor's office obsolete, if doctors and patients will use it.
“We know that a large percentage of our risk for developing certain diseases is related to genetics and related to our family histories,” acting Surgeon General Steven Galson said in an interview.
In the future, clinicians will predict risk and plan therapy based on information obtained from a drop of blood, but that future is still far off, Dr. Galson said. “We know that today, by using family history, we can get a lot of information that can help clinicians,” he emphasized.
The online tool, called My Family Health Portrait, collects information in a standard way that's easy for family members to share and for clinicians to use. “We'd like to see every single American have the opportunity to input their data into this tool and enable their physicians to treat them with a better understanding of family history,” he added.
“Family history can provide important insights into future risk of developing a variety of serious medical conditions like cardiovascular disease, diabetes, and [some] cancers,” Dr. Greg Feero, a senior adviser for genomic medicine at the National Institutes of Health, said in an interview. But many time-strapped clinicians don't collect family history during office visits. “The tool offers doctors and patients a convenient way to collect and organize an expanded range of family history information outside of the time constraints and pressures of the office visit,” Dr. Feero said.
My Family Health Portrait was introduced in 2004 as a form that patients could print and take to their medical appointments. But the revised version (available at https://familyhistory.hhs.gov
For example, if you create a file with your own history, you are prompted to note the dates when you had certain diseases (if any) or to add diseases not on the default list. You can also add health information about your immediate family members (siblings, parents, children, aunts, and uncles) with options to add more family members. If you give your brother the file, it asks him whether he is a family member and reorients the data around him. This prevents the duplication of data; your brother would only need to input health data that are unique to him.
According to the Department of Health and Human Services, building the basics of a family health history should take about 15-20 minutes. Beyond that, the more family members someone includes, the longer it takes. The history may be downloaded onto a patient's own computer, and it is not automatically accessible by the government or by any health care provider without the patient's permission.
Doctors who start an exam with an accurate family history at hand can spend their time reviewing and interpreting the information, rather than collecting it, Dr. Feero said.
“The new tool is designed using accepted data standards, so that the data file it creates has the potential to be shared electronically with electronic health record and personalized health record systems,” Dr. Feero noted. “Ultimately, this same standards-based design should allow the development of automated tools to help clinicians interpret the information the patients provide them.”
“If the clinician currently uses a paper-based patient family history intake form for new patients, or for yearly physicals, the provider could simply ask patients to complete the new tool online and supply them either with the data file or a paper version,” Dr. Feero explained. “If secure e-mail systems are available to the patient and provider, this might be another option for transferring the information.”
Alternatively, the entire program is available for downloading and customizing at no charge. Providers can install the My Family Health Portrait software as part of their health information technology system. Patients could complete the information at a kiosk or laptop in the waiting room, and have the electronic file sent directly to their physicians for review.
An electronic family history is potentially useful, Dr. Charles Scott, a pediatrician in private practice in Medford, N.J., said in an interview. But it would have to be reviewed and incorporated carefully, so that patients would not be able to access medical files other than their own if they completed the history in a doctor's office, he said. Software compatibility could be a problem in some practices, he added.
And it's important to remember the personal touch, no matter how much electronic media become part of medical practice. “My fear is that we may get so involved with our data entry in the e-chart that we will forget to warmly interact face to face with our patients,” Dr. Scott said.