Digital Tools Utilizing Patient Health Records Improve Lung Cancer Screening Rates

A comprehensive digital tool within electronic health records leads to more patients receiving the recommended screenings for lung cancer, according to a study published in JAMA Network Open.

Lung cancer remains a top cause of cancer deaths in the US. To catch it early, experts recommend using computed tomography (CT) scans for people with a history of smoking. Although CT scans can lower death rates by 20%, very few eligible people (6.5%) got this screening in 2020.

To improve screening rates, some U.S. healthcare systems have implemented digital tools that help clinicians decide when to order CT scans to screen patients for lung cancer. These clinician-facing tools integrate into electronic health record (EHR) systems. So far, studies have shown that these reminder tools can slightly increase the number of CT scans done for lung cancer screening.

Now, researchers from the University of Utah in Salt Lake City have developed a more comprehensive, multifaceted digital tool for lung cancer screening that integrates into EHR as well as patient portals. Their paper was published in JAMA Network Open in June 2024.

“We are excited for the findings from our study,” principal investigator Kensaku Kawamoto, M.D., Ph.D., told Managed Healthcare Executive in an email. “And [we] are thankful to the Agency for Healthcare Research and Quality for enabling this work. The underlying shared decision-making tools are available for free, including in stand-alone form at https://screenlc.com.”

Kawamoto and his colleagues developed a multifaceted digital tool that included clinician-facing reminders, narrative guidance in the process for ordering CT scans, and a shared decision-making tool, along with patient-facing reminders added to the patient portal.

The study was conducted using an interrupted time series design with three study periods from August 24, 2019, to April 27, 2022: baseline (12 months), period 1 (11 months), and period 2 (9 months). The study included 1,865 patients aged 55 to 80 years who had a history of smoking 30 pack-years or more. The researchers first introduced clinician-facing interventions in period 1, then added patient-facing reminders in period 2.

The primary outcome was to assess the lung cancer screening care gap closure, defined as the identification and completion of recommended care services. To count as gap closure, patients completed a CT scan for lung cancer screening, a chest CT for another reason, or participated in shared decision-making regarding lung cancer screening.

The results showed that the multifaceted intervention was associated with an increase in lung cancer screening rates. During the study, the gap in care for lung cancer screening improved from 15.9% to 46.9%. The introduction of patient-facing reminders in the second period of the intervention led to further increase in the care gap closure.

This study has several limitations. The nonrandomized design and lack of control groups may introduce bias, especially as the COVID-19 pandemic likely reduced screening rates due to decreased clinician availability. The pandemic also caused an unrelated increase in other chest CT scans. Also, many patients lacked detailed smoking histories, affecting eligibility determination.

Notably, this new lung cancer screening tool is part of a broader initiative called Reimagine EHR, which aims to improve healthcare “by making software that automatically integrates patients’ health records to help doctors provide personalized care,” according to a press release from University of Utah Health.

This study highlights the importance of utilizing digital tools and relevant information from patient health records to improve lung cancer screening rates, generate more provider-patient conversations about lung cancer screening, and potentially reduce lung cancer deaths.