Placing prompts in the electronic health record, reminding primary care physicians of patients’ potential eligibility for lung cancer screening, can increase the use of low-dose CT, according to a new analysis.
Providers have struggled to bolster the rates of screening for America’s No. 1 cancer killer. One recent study estimated that 3.2% of those eligible for such exams were actually imaged for lung cancer in 2017.
Scientists at Rutgers University recently sought to tackle this issue, sharing their work June 11 in the American Journal of Preventive Medicine [1]. The State University of New Jersey adopted two novel EHR workflow prompts in 2018, helping PCPs determine tobacco use and lung cancer screening eligibility, along with facilitating low-dose CT ordering for those who meet the criteria.
Rutgers has since seen marked gains, boosting the number of fully filled out patient records, patients eligible for screening, and completed orders for LDCT.
“Despite evidence of the benefits of early detection and clinical practice guidelines, LDCT lung cancer screening is widely underutilized,” Michael B. Steinberg, MD, MPH, with the Department of Medicine at the Robert Wood Johnson Medical School, and co-authors concluded. “This study shows the utility of EHR prompt implementation to accurately record tobacco use and intensity, allowing for easier identification of patients eligible for lung cancer screening and corresponding increases in LDCT utilization.”
For the study, Steinberg et al. retrospectively analyzed data from the year leading up to implementation and the year afterward. The final sample covered more than 48,700 patient visits. Rutgers prompt for smoking information pertinent to LDCT included smoking status, year started, cigarettes per day, calculated pack-years, whether they were counseled to stop, patient characteristics, and if the individual was a candidate for screening.
Following the change, the percentage of patients with complete data in their record leapt from 63% to 68%. And among those who met screening eligibility criteria, the percentage of LDCT orders increased from 14.6% before the EHR prompts to 36.6% afterward. The effectiveness of the prompt did not vary by any demographic characteristics, the authors noted.
“This study shows that implementation of EHR workflow prompts may offer a relatively simple yet highly effective way to increase LDCT screenings in eligible patient populations,” the authors noted. “In addition, the prompts provide the decision-making support that many providers need in real-world clinical settings.”
Read more about the study’s results, including potential limitations, at the link below
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.