Health system harnesses Epic EHR tool to bolster breast imaging uptake
A Wisconsin-based health system is offering details on how it has harnessed an electronic health record tool to bolster mammography uptake.
Breast cancer screening use is about 22% lower among Medicaid patients treated by 11-hospital Emplify Health (64% vs. 86% among others), experts wrote Tuesday in JACR. This despite the payment program covering mammograms throughout the organization’s service area. Meanwhile, rates for the uninsured are even lower, at about 61%.
Researchers with Emplify—a combination of Bellin and Gundersen Health System—tapped Epic Campaigns to improve these numbers. The program allows radiology providers to contact patients in bulk via their preferred method of communication.
Glen Ellen Whitfield, MD, and co-authors highlighted early progress, with about 13% of patients overdue for mammograms completing their exams within six months of receiving an alert.
“Epic Campaigns offers an easy-to-use, all-in-one platform to reach patients for preventive screening and to track outcomes,” Whitfield, a student with the Medical College of Wisconsin, and co-authors advised. “As people become more technologically experienced, use of tools such as this can help us to engage otherwise hard-to-reach patients.”
For the study, researchers used Epic to identify women ages 40 to 74 who were on Medicaid or uninsured and behind on breast cancer screenings. The search yielded a total of 5,336 individuals, with Emplify Health contacting them either via a patient portal message, text or snail mail, depending on their preference. Of those, about 13% (0r 701) completed their screening exam within six months (with greater success using electronic approaches).
Screening completion rates were “significantly” higher for women on Medicaid (15%) compared to the uninsured (6%).
“This statistically significant difference suggests that equipping women with government-subsidized insurance encourages completion of preventive screenings,” the authors advised. “That said, barriers to enrolling women on Medicaid need to be addressed, including stigma with the coverage, misunderstandings regarding what the program offers, a complex application process, and lack of healthcare literacy.”
Women living in rural, underserved communities also were less likely to complete screenings compared to those living in other geographies. Same for patients facing transportation challenges or housing and food insecurity. Other factors such as smoking status, body mass index, comorbidities and patient portal status also were significantly associated screening adherence. For instance, current smokers had the lowest rate of completed screening, while patients with higher body mass index recorded higher rates.
Whitfield and co-authors labeled uninsured status as a “significant” predictor of screening mammography noncompletion when compared to those on Medicare, Medicaid or private plans.
“Implementation of state-level Medicaid expansions and further efforts to identify and address barriers to enrollment may alleviate the financial burden and increase access to preventive screening in these women,” they advised.
The study is limited by its low response rate, with 87% not responding to the campaign, among other factors. Whitfield and colleagues said they plan to conduct additional Epic Campaigns to reach women who have not received screenings and potential new patients. They also plan to further investigate the barriers preventing women from pursing annual mammograms.
Read more in the Journal of the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.