Compatibility of Family History Cancer Guidelines With Meaningful Use Standards

Abstract

Purpose To evaluate the potential of implementing established family cancer guidelines as clinical decision support within meaningful use (MU)–compliant health information technology systems. Methods We conducted a systematic analysis of cancer guidelines involving family health history (FHx) published before 2015. By comparing existing cancer guideline statements to current MU FHx standard requirements, we determined whether the cancer guideline statements could be implemented as clinical decision support. For guidelines that could not implemented, we determined the primary reasons for incompatibility. Results A total of 531 statements from 55 guidelines published by 11 different organizations were reviewed and analyzed. Overall, 18% to 66% of guideline statements could or could not be implemented in MU-compliant health information technology systems, depending on which MU standard was used. Health Level Seven (HL7) models performed better than SNOMED models. Implementability of guideline statements varied by cancer type and guideline organizations. The greatest deficiencies in implementability of statements were largely a result of the fact that MU standards required only first-degree relatives and that FHx terms used in guidelines statements were ambiguous. Conclusion FHx cancer guidelines and MU-based systems vary widely and are mostly incompatible. We identified sources of incompatibility and made recommendations that could improve the implementability of FHx cancer guidelines. Our findings and recommendations can enhance the use of established FHx cancer risk guidelines in routine clinical workflows.