The genetic insights in family trees helps doctors prevent or treat patients’ conditions, but only a full picture of all blood relations can map potential risks. Collecting family and personal health histories used to involve a clipboard, paper checklist, and a doctor’s waiting room, but in a world of EHR’s, paper is obsolete. MeTree modernizes and improves the patient experience with an EHR-integrated web application for building comprehensive health histories and a clinical decision support engine that simplifies individualized recommendations.
Health histories are a central element of effective care, yet the systems for gathering family histories typically rely on a patient’s recall and rarely fit current standards for clinical information systems. The stress of a waiting room doesn’t help, and the series of checkboxes and fill-in-the-blanks don’t accurately capture the wealth of insight that genetic information can provide. That system requires transcription, and changing the entries after the fact is difficult.
For providers, effectively applying clinical knowledge based on these histories is another challenge. The rapid pace of change in clinical guidelines makes it difficult to stay current, especially outside of a provider’s field of expertise. Tracking a vast number of published clinical best practices is impossible for busy clinicians or their staff, and using those guidelines appropriately to individual patients over time is even harder.
Including new digital tools into provider’s existing EHR-driven workflow presented another problem. Providers said they wouldn’t use a new tool unless it fit in their existing routines.
MeTree is designed to collect and share health histories in ways that fit both patients and providers while making sense of clinical guidelines.
“MeTree solves a problem in clinical care by taking advantage of the assets of both patients and providers by redirecting workflow to accommodate out of office data collection and analysis and sharing synthesis results with patients and providers in a way the promotes shared decision making around risk management,” said Dr. Lori Orlando, Associate Professor of Medicine, Associate Director Program in Precision Medicine at the Duke Center for Applied Genomics & Precision Medicine.
MeTree gathers health histories from patients in an easy-to-complete web format and delivers them to providers with the patient’s other electronic records. The digital-only system eliminates transcription while providing more detailed health data in a format both parties can use. Richer histories reflect a more nuanced picture of a patient’s risk profile, and the web-based frontend makes it easy for patients to share details before they arrive at the office or with their provider during their consultation.
MeTree’s clinical guideline engine replaces the cumbersome research process with a continuously updated a database of recommendations from leading publications and medical authorities. Algorithms then compare patient data to that database and customize recommendations based on family history and other risk factors, including age.
MeTree tackles the data and integration challenges of older systems. The backend integrates with EHR’s to maintain clinicians’ existing workflow, rather than adding a stand-alone tool. Managed accounts allow patients to update information over time and port their data seamlessly among the providers they see in a health system.
Ease of use for the clinician was critical to the product’s success. Orlando said her team chose to partner with Little Green Software on this product specifically because of LGS’s experience building apps that seamlessly integrate with EHR frameworks. Little Green Software worked with Duke’s team to build and deploy MeTree as a SMART-on-FHIR app, which launches the app from inside Duke’s Epic EHR. That convenience means providers regularly use the tool to better understand their patients and the guidelines that can improve their care.
Providers and patients have transparent access to health history data without digging into paper intake forms or limiting the data they collect to a series of checkboxes. The system updates clinical recommendations and tailors them to individual patients, which allows providers to stay current without the administrative burden.
MeTree is also part of an NIH-funded trial testing the efficacy of digital tools in a range of settings with a range of populations.