MyLegacy is a web-based questionnaire asking for personal and family history as well as lifestyle and environmental influences, which is completed prior to a physician visit. The information provided by the patient is evaluated via complex algorithms established by the Genomic Medicine Institute at the Cleveland Clinic. Personalized risk levels are calculated for several disorders and provided to patient and physician along with recommendations regarding next steps and a pedigree for visualization of relationships. This application saves valuable physician time and ensures that patients at risk for hereditary and multifactorial diseases are identified and appropriate clinical measures can be taken.
- A primary care physician has a new 40 year old patient complete MyLegacy prior to their initial well visit. Review of the Disease Risk Reference report and family tree (pedigree) identifies a high/familial risk for colorectal cancer. The physician recommends that the patient begin screening for colorectal cancer and refers to a genetic counselor to determine whether genetic testing is indicated.
- An oncologist has a 58yo woman with breast cancer complete MyLegacy as part of her staging evaluation. Her Cancer Risk Reference report indicates high/familial risk for breast cancer. Genetic counseling and testing reveals that she has Hereditary Breast and Ovarian Cancer syndrome due to a BRCA2 mutation. This changes her clinical management to bilateral mastectomy and leads to early detection in her daughter.
- A cardiologist has a referral patient complete MyLegacy prior to their visit for diagnosis and treatment of an irregular heartbeat. Review of the Cardiovascular Disease Risk Reference report and family tree (pedigree) reveals a genetic risk for cardiomyopathy. The physician orders the appropriate diagnostic test (echocardiogram) and refers to a genetic counselor for potential genetic testing.
- A primary care physician has a 24 year old female Asian patient complete MyLegacy before her annual well visit. The Reference Risk Report reveals a high risk for diabetes based on her personal information (BMI 25kg/m2) and family history (patient’s mother carries a diagnosis of diabetes). Her physician orders a hemoglobin A1c as an appropriate screening test and counsels her on modifiable risk factors.
MyLegacy On FHIR Release No. v 1.0.2 (DSTU 2)
Requires Cerner releases compatible with SMART on FHIR app
"“Having rigorous family history information can dramatically improve the patient’s quality of life, and also the cost of treatment. We can’t afford any longer just to treat diseases as they arise. We need to get much better at preventing them. It’s the only way to bring costs down. I expect MyLegacy to spread quickly”
Dr. Daniel Sullivan, Primary Care Physician, Cleveland Clinic Family Health Center
MyLegacy provides a standardized, systematic intake of patient-entered personal and family history data for a consistent approach. Physicians have cited the lack of time and incomplete information provided as a barrier to collecting accurate family history which in turn leads to missed referrals. Patients can access MyLegacy from the comfort of their home and at their own pace, which improves the quality of the information provided and generates better clinical outcomes.
The MyLegacy result summary is integrated into the Cerner EHR for caregivers to reference. It includes risk levels, explanations of the different conditions, and recommendations for next steps to monitor or assess for the condition of interest. All of the conditions for which risk is assessed are actionable, meaning that early identification and treatment or prevention can lead to better clinical outcomes, quality of life, and increased life span for patients and their family members.
A pedigree (family tree) drawing is created within MyLegacy, outlining the relationships of affected individuals toward each other for better visualization and easier identification of at-risk family members.