TABLE 3.

Key informant interview considerations for family chart linking and facilitating cascade genetic testing in electronic health record systems.

Sociotechnical Model Component	Considerations for Family Chart Linking
Hardware and software	• Interoperability between systems is possible and essential for widespread implementation
	• Paradigm shift toward shared information across the charts of family members
Clinical content	• Standardized data formats for clinical information required (e.g., genetic test results)
Human computer interface	• Third party apps where patients control flow of their information are possible alternatives to sharing within an EHR system
People	• Patient preferences for sharing genetic information with family members not well understood
Workflow and communication	• Paradigm shift away from physicians as gatekeepers of patient data
	• Large changes to workflow may be barriers to physicians already busy with competing demands
Internal organization features (e.g., policies, procedures, and culture)	• Competing demands for systems with high IT resource needs
	• Perceived evolution away from family-based genetic testing to universal screening
External rules and regulations	• HIPAA compliance
	• Procedures for patient and relative to consent to chart linking unclear
Measurement and monitoring	• Alternatives may be more favorable than chart linkage tools (e.g., maintain status quo; patient-controlled third party apps; universal genetic testing rather than family linkage with cascade testing)