EHR Workflow Prompts Boost Lung Cancer Screening, LDCT Ordering

EHR workflow prompts increased the identification of patients eligible for lung cancer screening, according to a study published in The American Journal of Preventive Medicine.

Researchers implemented two novel EHR workflow prompts at Rutgers Robert Wood Johnson Medical Group, a university-affiliated network in New Jersey.

By streamlining the identification and quantification of patient tobacco use through EHR prompts, clinical staff could determine patient eligibility and seamlessly order low-dose computed tomography (LDCT) for eligible patients.

The research shows that implementing EHR workflow prompts may offer a relatively simple and highly effective way to increase LDCT screenings in eligible populations.

Additionally, the researchers noted that the EHR prompts provided clinical decision support that many providers need in real-world settings.

“Many physicians cite barriers to lung cancer screening in their practices, such as inadequate time and staffing, as well as the difficulties of addressing lung cancer screening when their patients have comorbidities,” the authors wrote.

“However, many suggested that EHR reminders to recommend screening for eligible patients would be helpful in implementing lung cancer screening within their clinics,” they added. “Providing a mechanism for single-click ordering of LDCT can help to overcome these barriers by simplifying the process.”

The authors mentioned that the study is subject to several limitations.

The impracticability of randomized controlled studies in real-world care settings makes studies on using EHR prompts to promote preventive measures relatively rare.

Since researchers conducted this retrospective review of EHR data longitudinally, patient smoking status could have changed over time. There could also be inaccuracies in the smoking data entered.

It is also unclear how many patients completed the ordered LDCTs, the authors pointed out.

“After much consideration, visit-level data were used as opposed to patient-level data as each encounter could be an opportunity to offer LDCT,” they wrote. “Data were analyzed both ways and were consistent.”

The authors also noted that there could be secular increases in LDCT ordering throughout the study. However, the analyses were limited to one year before and after the prompt was implemented to minimize this, and there was no pattern of increasing utilization in the 12 months before the implementation of the workflow prompts.

Further, the researchers based the study on the 2013 US Preventive Services Task Force eligibility criteria, which were most recently updated in March 2021.

Finally, the study did not address specific challenges related to shared decision-making, which is critical for the patient selection process for LDCT.

“It is critical that all patients considered for LDCT undergo shared decision-making and that this be documented in the EHR,” the researchers emphasized.