by Tom Wilemon
Collecting family health histories to identify patients at risk for hereditary cancers may seem a simple task, but it’s a complicated endeavor due to the multitude of ways information is compiled.
Some clinics still use paper questionnaires with numerous inquiries about other health data and rarely input family history into a separate record. Even when that information is filed electronically, it often ends up stored where it’s not readily available. Georgia Wiesner, MD, Ingram Professor of Cancer Research and director of the Clinical and Translational Hereditary Cancer Program, will lead an initiative to establish a streamlined process for collection of family health histories that could set the stage for a standardized system to make the information easily accessible. The project is supported by a $5.3 million grant from the National Cancer Institute’s Cancer Moonshot program.
“Family history is a very stable predictor of disease,” Wiesner said. “It’s been asked about in the clinical setting for years and years, but the information is either not collected at all because of time constraints or it is not collected in a standardized way.”
This is the second large Cancer Moonshot grant awarded to Vanderbilt researchers. Another team received an $11 million grant last year for colorectal cancer research. In addition to those grants, Vanderbilt-Ingram Cancer Center (VICC) is among the centers to have received Moonshot funding for tobacco cessation initiatives.
“The NCI Cancer Moonshot program provides unique opportunities to focus on the most compelling scientific questions and to develop strategies that accelerate the development of new cancer prevention and treatment. We are excited that our investigators are taking part in this initiative to expedite a new era in personalized cancer care,” said Jennifer Pietenpol, PhD, Executive Vice President for Research at Vanderbilt University Medical Center, director of VICC, Benjamin F. Byrd Jr. Professor of Oncology and holder of the Brock Family Directorship in Career Development.
The hereditary cancers initiative will use MeTree software, a web-based program developed by Duke Center for Applied Genomic and Precision Medicine to collect and analyze the family history.
It’s designed to be a tool for both clinicians and patients and their families. Vanderbilt researchers, including Health Information Technology, will collaborate on the project with researchers from Duke. Lori Ann Orlando, MD, associate professor of Medicine at Duke, is a co-principal investigator.
The IT specialists will work to make MeTree an integrative tool that can be used across multiple electronic health record systems.
“Vanderbilt Health IT has been on our pre-implementation, yearlong journey to figure out what would work here and the technical specifications we would need to go through to implement this,” said Sarah Bland, MPH, MBA, project manager with the Vanderbilt University Medical Center Department of Biomedical Informatics, who is assisting Wiesner in supervising the initiative.
“One of the reasons this project excites me is that it gets patients involved in their own care,” Bland said, noting that it has modules for patients to invite family members in compiling health information with hereditary implications.
The MeTree risk assessment platform collects data on 23 hereditary cancer syndromes as well as other information not directly related to cancer.
“The tool itself has a way to identify 45 different assessments and give you a report for those,” Wiesner said. “It also takes information on cardiovascular disease and other ailments. We are going to hit a home run if it can be used across systems.”
As medical care becomes more personalized and tailored to individual patients, it’s vital that clinicians be more diligent in collecting personal and family health history data on a reliable system.
“We’ve known for years that a patient with a strong family history of certain cancers has increased risk for developing cancer themselves,” said Dan Roden, MD, Senior Vice President for Personalized Medicine, Sam L. Clark Endowed Chair and Professor of Medicine, Pharmacology and Biomedical Informatics.
“Now that we have genetic tests to add to risk prediction, Dr. Wiesner’s Moonshot project is vital to enhance our ability to systematically identify patients at increased risk because of their family history so that we can offer them and their families genetic testing. Personalized medicine incorporates a vision that we use new tools like Dr. Wiesner’s Moonshot project to identify patients at increased risk for disease and individualize treatment for them. This approach will be important for many other diseases,” Roden said.
After a patient answers questions on an electronic device, MeTree alerts the patient and the clinician whether genetic counseling is warranted.
The patient interactions and collection of family data will initially occur at Vanderbilt Hereditary Cancer Clinics and the clinics at VICC. The risk assessments will then be deployed at primary care clinics at Vanderbilt and Meharry Medical College. Vanderbilt and Meharry use different electronic health record systems. Vanderbilt’s is Epic based, while Meharry uses eClinicalWorks.
“This is a very exciting opportunity for VUMC and our affiliated institutions to work together,” said Kevin Johnson, MD, MS, Cornelius Vanderbilt Professor and chair of Biomedical Informatics, professor of Pediatrics and Informatician-in-Chief.
“Sharing family history data across systems is essential for both good clinical care and, also, for secondary uses of clinical information for predictive analytics or other research purposes.
“It is a hard problem, but one that Dr. Wiesner, our Department of Biomedical Informatics, and the team at Duke are ideally suited to solve,” Johnson said.
The grant provides five years of funding for the researchers to develop a single clinical platform for the collection of family health histories.
