Table 2.
Themes and representative quotations identified from physician interviews.
| Theme | Quotation |
|---|---|
| Understanding & Awareness of FH | “But the initial management as far as I know is the same as anybody else.” (PCP) |
| “…I mean, I see people that carry that diagnosis [FH], but I don’t think I would, sort of, come up with it myself.” (Specialist) | |
| Clinical Workflow | “And to be honest, if I’m seeing them for strep throat, I might ignore it [CDS] or mention to them that they need to talk to their doctor about it. I will try to mention to a patient ‘hey you’re due for your lipids, you’re due for your colonoscopy, may I order those things for you?’ and if they say ‘yes’, I will, but if I have a 15-min appointment for their broken leg… I don’t know that I’m going to get into a huge discussion…” (PCP) |
| “I would counsel them, and then I would want to send them to the FH Clinic if they’re around or local. If not, you know, of course I’d start them on a statin, and then you’re kind of stuck because I wouldn’t feel comfortable ordering the genetic tests for them. That’s really the logical next step, in my opinion. In which case, you’d try to send them to Genetics and/or the FH Clinic.” (Specialist) | |
| Physician Preferences & Value of CDS Tools | “I would suggest one area that we constantly struggle with is finding the right orders in Epic when it’s orders that we haven’t done a lot of… so the more detail… showing you exactly how to find the right order would be very helpful… Because we have really struggled… with the amount of different things that we order, that has been a real hard spot…” (PCP) |
| “Personally, I guess that’s why I’m here, I would really prefer passive alerts… I think, where it was an active alert… people get alert fatigue, and they’re just going to click it to bypass it.” (PCP) | |
| Perspectives on Patient Needs & Values | “Because I’ve learned when I do risk counseling and I use the shared decision-making aid, which includes all the risk percentages…I’m learning as I teach my own patients, like, oh, yeah, that’s right, smoking does increase by this much, and so if you have something like that for FH, if you really want to drive home the point of how much greater risk, people who use that will start educating themselves in addition to their patients.” (Specialist) |
| Dissemination & Implementation | “I think whenever anything significantly new like this [CDS] is deployed; some type of communication is useful. I mean either in the EHR update, which many of us are actually reading now, or in like communication from leadership or through multiple approaches.” (PCP) |
| “The problem with BPA is, again, that just so many of them don’t apply. You really have to sort it out from them. You’d have to suppress everything that didn’t apply to me and patients…I’m just going to see a bunch of yellow and I’m going to ignore it because it’s not… it doesn’t apply to me, I’m therefore going to ignore everything and I’m going to miss the important alarms.” (Specialist) |
Abbreviation: PCP, Primary care physician; FH, Familial hypercholesterolemia; CDS, Clinical decision support.