Implementation of EHR workflow prompts at a medical group in New Jersey increased the identification of eligible patients for lung cancer screening and streamlined LDCT ordering. The prompts simplified the assessment of patient tobacco use, allowing for seamless ordering of LDCT. EHR workflow prompts offer a simple and effective approach to boosting LDCT screenings, providing valuable clinical decision support. However, the study is subject to limitations regarding data accuracy, patient completion of LDCTs, and adherence to updated guidelines.
A recent study published in the American Journal of Preventive Medicine reveals that the implementation of EHR workflow prompts has significantly facilitated the process of identifying patients eligible for lung cancer screening and streamlining the ordering of low-dose computed tomography (LDCT).
Conducted at Rutgers Robert Wood Johnson Medical Group, a university-affiliated network in New Jersey, researchers introduced two innovative EHR workflow prompts. These prompts effectively simplified the assessment and quantification of patient tobacco use, enabling clinical staff to determine eligibility and seamlessly order LDCT for eligible patients.
The findings highlight the potential of EHR workflow prompts as a straightforward yet highly effective approach to increasing LDCT screenings in eligible populations. Furthermore, the study demonstrates that these prompts provide crucial clinical decision support in real-world healthcare settings, addressing the challenges faced by many providers in implementing lung cancer screening.
Physicians often encounter barriers to lung cancer screening, such as time constraints, staffing limitations, and the complexity of addressing screening in patients with comorbidities. However, the study indicates that EHR reminders recommending screening for eligible patients can help overcome these obstacles by simplifying the process and even facilitating single-click ordering of LDCT.
The authors acknowledge certain limitations of the study. Given the impracticability of randomized controlled studies in real-world care settings, investigations on the use of EHR prompts to promote preventive measures remain relatively rare. Additionally, the retrospective review of EHR data over time raises the possibility of changes in patient smoking status and potential inaccuracies in the recorded smoking data.
Moreover, the study does not provide information on the number of patients who completed the ordered LDCTs. Nevertheless, the researchers justify their focus on visit-level data, as each encounter represents an opportunity to offer LDCT. Their analyses accounted for secular trends in LDCT ordering by examining data from one year before and after the prompt implementation, which revealed no significant pattern of increasing utilization before the workflow prompts.
It’s worth noting that the study relied on the 2013 US Preventive Services Task Force eligibility criteria, which have since been updated in March 2021. Future research could consider incorporating the latest guidelines to refine the effectiveness of EHR workflow prompts for lung cancer screening.
Lastly, while the study did not specifically address challenges related to shared decision-making, the researchers emphasize the importance of documenting such discussions in the EHR and ensuring that all patients considered for LDCT undergo shared decision-making as part of the patient selection process.
Overall, the study underscores the value of integrating EHR workflow prompts into clinical workflows to simplify lung cancer screening and LDCT ordering, thereby improving patient care and outcomes. These prompts offer a practical solution to enhance screening rates and support decision-making for healthcare providers in real-world practice.
