HIPAA Compliant
ISO 27001 CertifiedActively Recruiting
Led by University of Pennsylvania · Updated on 2025-07-20
1000
Participants Needed
1
Research Sites
N/A
Total Duration
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.
CONDITIONS
Using the EHR to Advance Genomic Medicine Across a Diverse Health System
B
Benita Weathers, MPH
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University of Pennsylvania
Lead Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Generic BPA, no nudge | Clinician nudge (order) | Clinician nudge (refer) | Patient nudge only | Clinician nudge (order) + patient nudge | Clinician nudge (refer) + patient nudge |
|---|---|---|---|---|---|---|
| What is it | Standard electronic best practice alert (BPA) delivered without behavioral nudges | Clinician is nudged via EHR to directly order genetic testing | Clinician is nudged via EHR to refer the patient for genetic testing | Patient is nudged via EHR or patient portal to pursue genetic testing | Both clinician order‑directed nudge and patient‑directed nudge are delivered | Clinician referral‑directed nudge combined with patient‑directed nudge |
| Primary use | Establish baseline alert impact without behavioral nudge | Assess whether prompting clinicians to order increases genetic testing uptake | Evaluate effect of clinician referral prompts on test uptake | Test whether patient‑directed prompts encourage testing engagement | Determine combined clinician order and patient prompt effect | Measure synergistic effect of referral‑directed and patient‑directed nudges |
| Evidence status | Evidence limited to trial design; outcome results not yet available | Effectiveness of clinician order nudges under investigation | Effectiveness of clinician referral nudges under investigation | Effectiveness of patient nudges being evaluated | Combined nudges effect will be determined by trial results | Combined clinician refer and patient nudges efficacy under study |
| Important limitations | No external usual‑care arm representing standard practice without any alert infrastructure | Behavioral effect may vary by clinician specialty or setting | Referral prompt effectiveness may depend on available genetics services | Patient engagement may be limited by portal access or health literacy | Combined approach may increase complexity of implementation | Synergistic effects may be confounded by system‑level constraints |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
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Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
Participants are identified using electronic health record algorithms and confirmed through medical record review.
Duration - Up to 3 years
Participants are monitored through their routine medical care where electronic nudges are delivered to clinicians and/or patients to encourage genetic testing when appropriate.
Nudges are delivered at scheduled medical appointments; patient nudges are sent via text message within 72 hours before appointments, and clinician nudges appear during clinical visits.
Study Type
INTERVENTIONAL
Masking
QUADRUPLE
Allocation
RANDOMIZED
Model
FACTORIAL
Primary Purpose
HEALTH_SERVICES_RESEARCH
Number of Arms
6
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Anna C Raper, Benita L Weathers, Theodore G Drivas...
https://pubmed.ncbi.nlm.nih.gov/39160614/University of Pennsylvania
Lead Sponsor
