Family physicians’ experiences with an electronic medical record-integrated family history collection strategy: a qualitative study

Background A complete, up-to-date family history (FH) is imperative in primary care to identify those at increased risk of heritable conditions who may benefit from personalized screening and management. Complete FH is rarely documented in the electronic medical record. Aim To understand family physicians’ experiences of an electronic medical record-integrated FH strategy. Design & setting A descriptive qualitative study using 1:1 interviews to assess a FH strategy. Strategy: Emailed patient invitation to complete FH questionnaire, automatic electronic medical record upload, family physician notification and links to clinical support tools. Setting: Randomly selected primary care teams affiliated with University of Toronto Practice-Based Research Network in Ontario, Canada. Participants: Family physicians from 3 sites that implemented the strategy. Method Telephone interviews with family physicians. Thematic analysis used for identifying, analyzing and reporting patterns in the data. An iterative process was used, with modification of interview and coding guides as new themes emerged. Results 14/15 family physicians were interviewed. Six major themes identified: 1. FH informs hereditary risk and enables tailored patient care; 2. Routine, intentional FH collection by patients and family physicians is essential; 3. FH collection supports meaningful patient–physician discussions and quality care; 4. Point-of-care tools enhance family physician awareness and knowledge; 5. Success is supported by patient engagement and electronic medical record integration; 6. Tailored approaches are needed to improve acceptability. Conclusion Physicians expressed the importance of routine FH collection and its implications for clinical management. Factors contributing to the strategy’s success included being patient-initiated and medical record integration.