1. Implementing a clinical partnership to provide telegenetics
services at community sites without access to genetic counselors
Neeraja Reddy1, Elisabeth M. Wood1, Diana Harris1, Stephanie Jideama1, Patrick Higgins1, Rishi Sawhney2, Priya Singh2, Kimberly
Vidrine2, Harriet Pinkston2, John Shevock2, Jan Jaeger1, Angela Bradbury1
1. University of Pennsylvania, 2. Bayhealth Medical Center
Background
Considerations for start-up
Uptake of genetic testing
This presentation is the intellectual property of the author/presenter. Contact angela.bradbury@uphs.upenn.edu for permission to reprint or distribute.
American Society for Human Genetics Annual Meeting, 2016
• Disparities in genetic services are well
documented in geographically underserved
locations with limited in-person genetic
providers1,3. Time and cost of traveling to major
health care systems to receive genetic services
increases burden on patients, discouraging
patients from receiving genetic services or
receiving services without access to genetic
counselors.
• A NIH-funded study evaluated the use of real-
time two-way videoconferencing (RTVC) to
provide cancer genetic counseling at multiple
community practices. The study reported that
most patient were satisfied with their remote
visits and had favorable patient reported
outcomes2.
• One participating site, Bayhealth Medical
Center, established a clinical contract to
maintain continuity of telegenetic services at
the close of the pilot-study.
• Equipment: Computers, web-cameras, headphones, technology cart, phones and HIPPA complaint RVC platforms.
• Other considerations: Personnel, including genetic counselor and other staff, genetic counselor licensure, and office
space appropriate for conducting RVC sessions
Referral
•Site receives
referral,
assesses
interest in
genetic
counseling
•Collects
medical and
family history
information
Pre-test genetic
counseling
• GC provides
pre-test
counseling
using V/C
• GC orders the
test, and
provides clinic
note to the site
physician
Post-test genetic
counseling
• GC receives
test results,
discloses
results using
V/C
• Provides
documentation
to the patient
and ordering
physician
Methods
BRCA 1/2
24 (26%)
Single-site
9 (10%)
Panel test
57 (61%)
Other
3 (3%)
VUS 14
(15%)*
Positive 11
(12%)
Negative 68
(73%)
0
2
4
6
8
10
12
14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
Mar-16
Apr-16
May-16
Jun-16
Jul-16
Aug-16
Sep-16
NumberofPatientSessions
Month
Pre-test Counseling Sessions
(n=118)
Disclosure Sessions (n=85)
Technology outcomes
Genetic counselors code each session as completed, completed by difficulty or aborted
based on the feedback from patients and their own perspective. Aborted sessions are
completed by switching to a different videoconference platform or via phone.
0
10
20
30
40
50
60
70
80
90
100
Pre-test counseling (n=116) Post-test counseling (n=74*)
Percentage
Completed
Completed with difficulty
Aborted
• Collaboration with site
coordinators for
scheduling/sharing
information
• On-site physicians remain
the ordering physicians
• Close communication
between the genetic
counselor s and site
physician (e.g. clinic
notes, support for
complex cases)
• Technology team
monitors and tracks tech
related issues
Conclusion
Remote two-way videoconferencing services can be implemented through clinical
contracts to provide access to genetic services at community sites without genetic
counselors, providing a novel delivery model to enhance the dissemination of and reduce
disparities in access to cancer genetic services.
Figure 2: Number of genetic counseling sessions
Results of the first 2 years of clinical partnership
• 191 patients have been referred to the program by on-site physicians
(n=105, 55%) and local community doctors (n=86, 45%). The majority of
referrals are from oncologists (52%) and surgeons (32%).
• A summary of completed sessions by month can be seen in Figure 2.
Figure 1: Telegenetics Workflow
Figure 3: Type of Test Figure 4: Results
• 93 patients chose to pursue genetic testing.
Figure 3: Technology session for sessions conducted
References
Armstrong J, et al. JAMA Oncol. 2015;1(9):1251-1260
Bradbury, A., et.al (2016). Journal of Medical Internet Research, 18(2), e23
Patrick-Miller, et. Al (2014). JMIR Research Protocols, 3(4), e49.
Completed: Zero to two minor technical problems (e.g. momentary screen freeze or audio
skipping)
Completed with difficulty: Significant technical challenges (e.g. repeated or complete
program freezing, prolonged reduced audio/video quality, etc.)
Aborted: Complete technical failure in which the counselor was unable to proceed (3
sessions completed by switching to a difference V/C platform and 1 by phone)
Clinic Volume
*VUS rate for patients who opted for panel
test was 21%