Family physicians' experiences with an electronic medical record-integrated family history collection strategy: a qualitative study.

Abstract

A complete, up-to-date family history (FH) is imperative in primary care to identify those at increased risk of heritable conditions who may benefit from personalised screening and management. Complete FH is rarely documented in the electronic medical record (EMR). To understand family physicians' (FPs') experiences of an EMR-integrated FH strategy. A descriptive qualitative study was conducted using one-to-one interviews to assess a FH strategy. Primary care teams, affiliated with University of Toronto Practice-Based Research Network in Ontario, Canada, were randomly selected. The participants were FPs from three sites that implemented the strategy. Telephone interviews were undertaken with FPs. Thematic analysis was used for identifying, analysing, and reporting patterns in the data. An iterative process was used, with modification of interview and coding guides as new themes emerged. A total of 14 out of 15 FPs were interviewed. The following six major themes were identified: 1) FH informs hereditary risk and enables tailored patient care; 2) routine, intentional FH collection by patients and FPs is essential; 3) FH collection supports meaningful patient-FP discussions and quality care; 4) point-of-care tools enhance FP awareness and knowledge; 5) success is supported by patient engagement and EMR integration; and 6) tailored approaches are needed to improve acceptability. Physicians expressed the importance of routine FH collection and its implications for clinical management. Factors contributing to the strategy's success included being patient-initiated and medical record integration.