CRA Health's software can interface with any EHR, radiology information system (RIS) or software program that is Health Level 7 (HL7) compliant.
Unfortunately, EHRs have very limited capabilities when it comes to genetics or risk assessment, so while CRA Health can push data into any EHR, most EHRs lack the functionality to receive that data in a useful or meaningful way.
The American Health Information Community (AHIC) developed a core data set in 2009 that any software package or EHR should be able to collect in order to be useful for managing the role of genetics in medical care. (New Standards and Enhanced Utility for Family Health History Information in the Electronic Health Record: An Update from the American Health Information Community's Family Health History Multi-Stakeholder Workgroup W. Gregory Feero, MD, PhD, et al.)
While CRA Health can collect all the required data points and many more, EHRs still are unable to collect and store even a minimal subset of the core data set. Thus, if CRA Health pushed even the minimum data set into an EHR, the EHR would lose most of that data.
EHRs today cannot record genetic test results in a structured format, or link genetic test results to the relative tested. They cannot draw pedigrees, cannot run risk algorithms, run models or guidelines, and they cannot do the clinical decision support that helps manage a genetics program. Of special note, EHRs do not include the patient in the family history and thus often miss a key person in the family...the patient. Seeing the patient's medical history, family history, ethnicity and genetic test results in an EHR usually requires opening four separate screens, most of which only show free text.
This brings up how data can be exchanged between EHRs and useful software packages such as that provided by CRA Health. This is known as interoperability and is dependent on standards. Standards provide a uniform and accepted way to structure data for transmission between software packages. The most widely adopted standard is HL7 which is used internationally for this purpose. HL 7 created the "pedigree model" (Kevin Hughes, MD, Amnon Shabo and the Clinical Genomics Special Interest Group) which can transmit family history and risk information without loss of information or integrity. While the Surgeon General's MyFamily Health Portrait tool, CancerGene software, the Bayes Mendel Web Service, CRA Health, PenRad, the American Society of Breast Surgeon's Mastery of Breast Surgery Program, and other software seamlessly exchange information using this international standard, no EHR is currently able to send or receive family history and genetic test results using this method.
This problem is solvable. EHRs need to adopt the core data set at a minimum, in order to store the data needed in the genomic age. EHRs need to be able to be interoperable using the accepted HL7 standard. And ideally, they need to open their data to allow external modular software to do the work needed to make medical care better, and allow storage of that data and results in the EHR. It will be impossible for 600 EHRs to develop 600 independent approaches to managing the plethora of genetic data that will soon be available. Using a modular approach makes a lot more sense (anyone who has more than one app on their smartphone understands that one monolithic EHR vendor trying to be all things for all people is doomed to failure).
In the meantime, CRA Health's products do what other useful software packages do: We collect, analyze, and store the structured data in our system, and push a report or note into the EHR. (One way CRA Health can share patient information in summary form is through an HL7 standard known as the "Continuity of Care Document")
This concept is similar for pathology software—storing the useful structured data in their database where it can be used for quality control , can ensure tracking of specimens with reports, and can be used for research. The software than sends a text report to the EHR, which the EHR can handle.
Mammography reporting systems are similar, as are anesthesia systems and other specialty specific systems.
The bottom line is that CRA Health can store the core data set from AHIC and more, and can transmit that information using HL7. Your EHR should be able to do the same. If it can't, maybe you should ask why not?
About the Author: Kevin S. Hughes, MD, FACS
Kevin S. Hughes, MD, FACS is a co-founder and medical advisor to CRA Health. Dr. Hughes is the Massachusetts General Hospital’s Surgical Director of the Breast Screening Program, Surgical Director of the Breast and Ovarian Cancer Genetics and Risk Assessment Program, and Co-Director of the Avon Comprehensive Breast Evaluation Center, and serves as the Medical Director of the Bermuda Cancer Genetics and Risk Assessment Clinic. He is an Associate Professor of Surgery at Harvard Medical School. Dr. Hughes is actively involved in the establishment of standards and in research regarding the genetics, screening, diagnosis, and treatment of breast cancer. He is the author of numerous papers and book chapters on the subjects of breast cancer, screening, diagnosis and treatment, and risk assessment. More information can be found at: thebreastcancersurgeon.org.