Clinicians Unlikely to Access Patient Genomic Data in the EHR

Clinicians viewed only 1 percent of patient genomic data in the EHR, according to a study published in the Journal of the American Medical Informatics Association Open (JAMIA Open).

Genomic testing has become an important tool to enhance clinical decision-making and precision medicine. Attaining the full benefits of precision medicine relies mostly on understanding how clinicians utilize genomic data, the study authors wrote.

Thus, researchers implemented the Electronic Medical Records and Genomics (eMERGE) Network into the EHR to evaluate how clinicians engage with genomic data. This platform gathers and displays genetic testing data in EHR systems.

The research team uploaded 1,071 genetic tests into the iNYP “genetics” section. iNYP is a hospital-supported web-based platform that displays patient data. The researchers defined clinician engagement with genetic test results as any interaction with the iNYP “genetics” section, such as an attempt to access the section or view a genetic test report.

Overall, the researchers retrieved 30 clinician access logs. Of the 30 clinicians, only 13 opened at least one test result document. This number represented 1 percent of the 1,071 genetic study results that the researchers uploaded onto iNYP.

Nineteen clinicians practiced internal medicine and 11 were in other specialties, like anesthesiology, surgery, radiology, neurology, and pathology.    

Thirty-seven percent of users accessed the logs around the time of a scheduled patient visit. Another 37 percent utilized the logs during a patient hospitalization, 17 percent accessed the platform as a participant’s established outpatient provider, and 10 percent were undefined.

“Overall, few users in our study went on to view participants unsolicited genetic test results in the EHR, regardless of whether the findings were positive or negative,” wrote the study authors.

“Unlike recent network studies on physicians’ attitudes toward unsolicited genetic test results, which use surveys and qualitative interviews, our study used objective and disease-agnostic data to assess the scope of clinician engagement with unsolicited genomic data,” the study authors continued.

The researchers made observations on the users who viewed the test results, rather than those who accessed the section before moving on quickly to another section.

As noted, clinician specialty and levels of training were linked to the access logs.

“For example, an attending physician, in internal medicine, seeing nonacute patients in an outpatient setting, may rely on a broad range of data for medical decision-making. In contrast, a junior resident-level physician in anesthesiology, performing pre-operative evaluations in acutely ill, hospitalized patients, may review EHR data in a more task-specific and narrow scope,” said the study authors.

“These observations also give rise to questions that merit further investigation, such as the influence clinical role plays in the navigation and integration of patients’ EHR and genomic data, and the use of this information in users clinical decision-making.”

A key strength of the study included using EHR access logs to evaluate clinician engagement with genomic data. Leveraging EHR access logs could help health systems prove the importance of certain types of data and how clinicians access different data types.

“These data contribute important empirical knowledge on the application of objective EHR log data to evaluate clinician engagement with genomic data and with unsolicited findings displayed in the EHR, within a clinical context,” the study authors concluded.

“It also provides insights into the informational and workflow needs of users and adds some valuable insights into types of activities that clinicians were engaged in when they accessed the unsolicited genetic test results. This study highlights opportunities to use EHR logs in ongoing EHR-integration efforts in both research and healthcare settings.”