Using Behavioral Economics and Implementation Science to Advance the Use of Genomic Medicine Utilizing an EHR Infrastructure Across a Diverse Health System

What this Trial Is About

Researchers are investigating new ways to deliver genomic medicine by using electronic health record (EHR) systems to support genetic testing in patients whose results can change medical management. This study evaluates clinician- and patient-directed nudges based on behavioral economics to increase the use of genetic testing across a diverse health system. The trial aims to refine patient identification algorithms and assess implementation strategies through a pragmatic randomized clinical trial involving multiple specialties and conditions. Participants include specialist clinicians randomized into six groups receiving different types of nudges: clinician nudges to order or refer for genetic testing, patient nudges via text message, combinations of both, a generic clinician alert, or usual care. The interventions use EHR tools such as Best Practice Alerts, SmartSets for ordering tests and referrals, and informational websites. Patients identified by electronic phenotype algorithms are enrolled and nudged accordingly. The trial runs over three years, monitoring genetic testing rates and implementation outcomes. Clinicians and patients participate through their routine medical visits where EHR alerts prompt actions related to genetic testing. Patient engagement includes receiving educational materials and text messages before appointments. Outcomes measured include rates of genetic testing, test orders or referrals, patient engagement, detection of genetic variants, and clinician actions. The study includes ongoing monitoring of nudge delivery and trial fidelity, with results shared through multiple dissemination platforms to support broader adoption of genomic medicine.

Using the EHR to Advance Genomic Medicine Across a Diverse Health System