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NHGRI Supports CMS Plan on Adding Family History Data to Electronic Health Records

By Matt Jones

NEW YORK (GenomeWeb News) – The Centers for Medicare and Medicaid Services is making plans to begin paying some healthcare providers to collect and add family health history information to patients' electronic medical health records, a policy that is supported by the National Human Genome Research Institute.

CMS has posted a public notice of the proposed rule change and is seeking comments on its plans to have Medicare and Medicaid pay for the addition of family history information to EHRs, which would begin in 2014.

CMS has proposed that certain eligible healthcare professionals and hospitals that can prove they meet certain criteria through the adoption and use of certified EHRs, under an initiative called the EHR Incentive Programs, can be reimbursed for the collection and use of structured family health history information. The initiative was launched by the Office of the National Coordinator for Health Information Technology.

"We believe that the realization of genomic medicine hinges on the ability of healthcare practitioners to capture and interpret genomic information in electronic health records," NHGRI Director Eric Green said in a recent statement. "Family health history information is foundational for both clinical and research purposes."

NHGRI said that family health history could be "one of the most powerful tools for promoting health, and that it is "critical for the appropriate interpretation of genetic and genomic test results."

Greg Feero, NHGRI's special advisor to the director for genomic medicine, told Genomeweb Daily News today that family history information is important for clinical medicine in general, and for genomic medicine and research in particular.

"Most current HIT systems do not really have robust capabilities to collect and structure family history information. It is hoped that this [initiative] will serve as a driver for that kind of data capture for clinical medicine," Feero said.

"From NHGRI's perspective, it will become increasingly important to have robust family history information available in HIT systems as we begin to get more and more genomic data coming into the clinical system. Interpreting all that information is going to require context. Some of that context will be standard clinical things, such as smoking, body fat, fast food intake, but it also will be very helpful to have family history information," he told GWDN.

CMS is currently taking public comments on the EHR program and has placed a specific focus on the criteria that is required for institutions to meet the agency's goals for making "meaningful use" of the EHRs and health information.

"Essentially, the criteria come out as sort of a smorgasbord of criteria, and the institutions can actually select from a menu of things that they might achieve in order to get reimbursed. That was done because not every institution has a system that can meet all of the criteria," Feero said.

These "meaningful use" objectives are spread over five years and through three stages, including a first stage that started last year and involves data capture and sharing goals. The second stage focuses on advancing clinical processes, and a third stage that will begin in 2015 will monitor the improvement in clinical outcomes.

For this EHR incentive program, the Office of the National Coordinator wants institutions to use EHRs to improve quality, safety, efficiency, and reduce health disparities; engage with patients and family; improve care coordination and public health; and maintain privacy and security of patient health information.

CMS hopes that compliance with these "meaningful use" goals for EHRs will lead to better clinical and population health outcomes, increased transparency and efficiency, empowered patients, and better research data on health systems.

Feero said that there already is a value for better and more easily accessible family history information in genomic medicine.

"You could see a scenario as a clinical practitioner where you're handed a snip panel by a patient that predicts that they have a low or moderate risk for CAD, but the family history suggests a strong risk.

"How would you interpret that risk panel with and without that family history information? Obviously, you might mislead the patient regarding the personal risk, at least with what we know about risk right now, if you only had the snip panel," he said. "But if you have the family history data robustly captured you could provide a much more accurate picture of their risk."

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