Is it True? EHR Workflow Prompt Can Boost Lung Cancer Screening?

What is EHR Workflow Prompt?

The electronic health record (EHR) workflow is an essential component of modern healthcare systems.

It helps providers manage patient information, streamline processes, and improve patient care. 

An Example of a Typical EHR Workflow Prompt

1. Patient Registration: When a patient arrives at the healthcare facility, the front desk staff collects their demographic and insurance information. This information is entered into the EHR system to create a patient record
2. Chief Complaint and Medical History: The provider reviews the patient’s chief complaint and conducts a comprehensive medical history interview. The provider documents this information in the EHR, including past medical conditions, medications, allergies, and family history
3. Vital Signs and Measurements: The medical assistant or nurse measures the patient’s vital signs like blood pressure, heart rate, temperature, and weight. These measurements are recorded directly into the EHR system, either manually or through integration with devices
4. Ordering Diagnostic Tests: Based on the patient’s condition and medical history, the provider may order diagnostic tests. This can be done electronically through the EHR, where the tests are selected, and necessary details are entered. The order is then sent to the appropriate department for processing
5. Test Results and Documentation: Once the tests are performed, the results are generated and transmitted back to the EHR system. The provider reviews the results, interprets them, and documents the findings in the patient’s record. The EHR allows for easy access to historical results for comparison and analysis
6. Treatment Plan and Medication Prescription: After reviewing the patient’s test results, the provider formulates a treatment plan. This may involve prescribing medications, scheduling follow-up appointments, or referring the patient to a specialist. All relevant details, including prescriptions, dosage, and instructions, are recorded in the EHR
7. Care Coordination and Referrals: If necessary, the provider may coordinate care with other healthcare professionals like specialists or therapists. Referral information, including the reason for the referral and the recommended provider, is documented in the EHR system. This ensures seamless communication and continuity of care
8. Follow-up Appointments and Reminders: The EHR system can generate automated reminders for follow-up appointments, medication refills, or preventive screenings. This helps in managing patient schedules and ensures timely care
9. Billing and Coding: The EHR captures relevant data for billing and coding purposes. It streamlines the process of submitting claims to insurance companies and reduces paperwork
10. Review and Continual Updates: The patient’s EHR is regularly reviewed and updated during subsequent visits or encounters. Providers can access the complete medical history, including past diagnoses, treatments, and interventions, to make informed decisions

What is Lung Cancer Screening?

Lung cancer screening is a preventive measure used to detect lung cancer in its early stages, even before symptoms develop. It involves using specific tests to identify abnormalities or nodules in the lungs that may indicate the presence of cancer.

What is LDCT Ordering?

LDCT ordering refers to the process of requesting and ordering a low-dose computed tomography (LDCT) scan for a patient. LDCT is a type of imaging test that uses X-rays to create detailed cross-sectional images of the lungs. It is commonly used for lung cancer screening in individuals at high risk for developing the disease.

The LDCT Ordering Process

1. When a provider determines that a patient meets the eligibility criteria for lung cancer screening based on factors such as age, smoking history, and other risk factors, they may order an LDCT scan
2. The ordering process typically involves initiating a request for the scan through the EHR system or a computerized physician order entry (CPOE) system
3. The provider may select the appropriate indications for LDCT screening and specify any additional details relevant to the patient’s condition
4. Once the LDCT order is placed, it is transmitted to the radiology department or imaging facility where the scan will be performed
5. The radiology staff then schedules the patient for the LDCT scan, taking into account factors like the availability of equipment and patient preferences
6. The patient will receive instructions on any necessary preparations for the scan, like fasting or avoiding certain medications
7. During the LDCT scan, the patient lies on a table that moves through a donut-shaped machine called a CT scanner
8. The scanner takes multiple X-ray images from different angles, which are then processed by a computer to create detailed images of the lungs
9. The resulting images can help detect abnormalities, including suspicious lung nodules or lesions that may indicate the presence of lung cancer
10. After the LDCT scan is completed, the radiologist interprets the images and generates a report with the findings
11. The report is typically communicated back to the ordering healthcare provider through the EHR system or other means
12. The provider reviews the report and discusses the results with the patient, recommending further actions or follow-up as necessary

LDCT ordering plays a crucial role in the process of lung cancer screening, allowing eligible individuals to undergo the necessary imaging tests for early detection and potential intervention if abnormalities are detected.

The study by The American Journal of Preventive Medicine

• According to a study published in The American Journal of Preventive Medicine, implementing EHR workflow prompts can simplify the identification of patients eligible for lung cancer screening and streamline the process of ordering low-dose computed tomography (LDCT) scans
• Researchers at Rutgers Robert Wood Johnson Medical Group implemented two EHR workflow prompts to improve the identification and quantification of patient tobacco use, enabling clinical staff to determine eligibility and order LDCT scans for eligible patients seamlessly

The study highlights that EHR workflow prompts offer a simple and effective way to increase LDCT screenings in eligible populations. The prompts not only facilitate the identification of eligible patients but also provide valuable clinical decision support to providers in real-world settings. 

• Physicians often face barriers to lung cancer screening like time constraints, staffing issues, and challenges associated with comorbidities in patients
• However, EHR reminders and a mechanism for single-click ordering of LDCT can help overcome these barriers by simplifying the process
• The study acknowledges certain limitations, including the impracticability of conducting randomized controlled studies in real-world care settings for promoting preventive measures
• Additionally, the patient’s smoking status may have changed over time, leading to potential inaccuracies in the smoking data entered
• The number of completed LDCT scans was unclear, and the analyses focused on visit-level data rather than patient-level data
• The study used the 2013 US Preventive Services Task Force eligibility criteria, which were last updated in March 2021
• It also did not address specific challenges related to shared decision-making, which is critical for the patient selection process for LDCT
• The researchers emphasize the importance of documenting shared decision-making in the EHR for all patients considered for LDCT

Our Take: How Does EHR Workflow Prompt Boost Lung Cancer Screening?

The EHR workflow prompt can contribute to boosting lung cancer screening in several ways.

1. Standardized Documentation

• The EHR workflow prompt ensures that healthcare providers have a standardized approach to documenting and reviewing patients’ eligibility for lung cancer screening
• The prompt can include specific criteria such as age, smoking history, and quit duration to help providers quickly identify eligible individuals

2. Decision Support Tools

• The EHR system can integrate decision support tools that assist providers in determining a patient’s eligibility for lung cancer screening
• These tools can analyze patient data like age, smoking history, and other risk factors, and provide recommendations based on established guidelines
• This ensures that providers have the necessary information at their fingertips to make informed decisions about screening

3. Automated Reminders and Notifications

• The EHR workflow prompt can incorporate automated reminders and notifications to alert providers when a patient becomes eligible for lung cancer screening based on their age and smoking history
• These reminders can help ensure that screening opportunities are not missed and that eligible patients are promptly identified and offered the screening

4. Seamless Test Ordering and Result Management

• The EHR system can facilitate the ordering of low-dose computed tomography (LDCT) scans for lung cancer screening
• Providers can initiate the order directly from the patient’s electronic record, streamlining the process and reducing the chances of errors or delays
• The system can also manage the results of the screening tests, allowing providers to easily access and review the findings

5. Follow-up and Tracking

• The EHR workflow prompt can include features for tracking and managing follow-up appointments for patients who undergo lung cancer screening
• The system can generate reminders for future screenings based on the recommended frequency and monitor patients’ adherence to the screening schedule
• This helps ensure continuity of care and improves the chances of detecting lung cancer at an early stage

6. Population Health Management

• By utilizing the data collected in the EHR system, healthcare organizations can analyze population-level information to identify individuals who may be eligible for lung cancer screening but have not yet been screened
• This population health management approach allows providers to proactively reach out to these individuals, educate them about the benefits of screening, and encourage them to undergo the necessary tests

Final Thoughts

The EHR workflow prompt facilitates the efficient and systematic integration of lung cancer screening into routine clinical practice. It improves the identification of eligible patients, supports decision-making, streamlines test ordering and result management, and enhances follow-up and tracking. These benefits contribute to increased uptake of lung cancer screening and ultimately improve the early detection and management of lung cancer.

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