Pathologists and clinical laboratory managers may find new opportunities to increase testing volumes as patients’electronic health records yield clinically relevant data
Sophisticated use of electronic health records (EHRs), automated reminder systems, and telephone follow-up can double cancer-screening compliance by consumers. That could mean an increase in testing volumes for clinical laboratories serving clinics using this approach.
Researchers at the Group Health Research Institute (GHRI) used electronic health records to identify Group Health Cooperative (GHC) patients who weren’t screened regularly for cancer of the colon and rectum.
Because of how EHRs were used to step-up patient compliance for cancer screening, the study findings may be useful for pathologists and clinical laboratory managers. Over the years, many medical laboratories have furnished referring physicians a list of their patients who are due for screening tests, such as for cervical cancer.
Currently, clinical labs now have direct interfaces between their laboratory information systems (LIS) and the physicians’ EHR systems. That gives these labs the capability to participate in a more engaged way to help physicians identify patients who would benefit from updating their medical laboratory tests. From that perspective, the findings of this Group Health Cooperative study can help pathologists and medical lab professionals develop new ways to add value to their client physicians.
Rates of On-Time Colorectal Cancer Screening Doubled
The scientists at GHC, a Seattle, Washington-based non-profit, used stepped interventions to encourage patients to be screened, according to a press release published at eurekalert.org. The interventions included automated letters and follow-up phone calls from medical assistants and nurses.
“With a simple centralized program, we leveraged our electronic health records to identify those who needed screening,” stated Beverly Green, M.D.. “We doubled colon cancer screening rates.”
Green is a practicing family physician at GHC. She is the lead study author and an affiliate investigator at GHRI. The researchers called the trial “Systems of Support to Increase Colorectal Cancer Screening,” or SOS. First, SOS mined EHR data from 4,675 GHC patients who were not up-to-date for colorectal cancer screening. The patients ranged in age from 50 to 73.
The patients were randomly assigned to one of four groups. Here is a break down of the progressively proactive interventions offered to each group:
- Group one received “usual care.” This included both patient and clinic reminders for those who were overdue for screening.
- Group two received “usual care” plus “automated care.” This included the additional intervention of a mailed letter reminder and a pamphlet about screening choices.
- Group three received all of the above interventions plus a call from a medical assistant (MA). The MA provided simple assistance to help get the screening preferred by the patient.
- Group four received the preceding interventions plus “navigated care.” A nurse called to advise patients in this group and to help them manage the screening process.
Increased intervention increased the percentage of patients who were current for colorectal screening for both years of the study, according to the press release. The increases achieved were:
- 26% for group one
- 51% for group two
- 57% for group three
- 65% for group four.
Annals of Internal Medicine published the findings of the randomized controlled trial in its issue dated March 5, 2013.
Need to Increase Screening Rates for Colorectal Cancer
Colorectal cancer is the third most common cancer in adults in the United States, according to the Centers for Disease Control and Prevention (CDC). It is the second leading cause of cancer-related deaths. The disease is highly treatable if detected early.
Colon cancer screening rates, however, tend to be much lower than other cancers. The inconvenience and discomfort involved in the screenings discourages some patients from following through, according to Green.
Testing Recommendations Included FOBT Performed by Clinical Labs
Group Health and the U.S. Preventive Services Task Force recommendations for colorectal cancer screening include three options: (1) colonoscopy every ten years; (2) flexible sigmoidoscopy every five years with one fecal occult blood test (FOBT) in between; or (3) FOBT every year.
At one end of the scale, colonoscopy, the gold standard for colorectal cancer screening, can detect precancerous lesions. However, it can require one or two days of missed work and the prep can be uncomfortable, Green noted. On the other hand, the FOBT is more convenient, but detects only about 75% of colon cancers.
“Traditionally, the onus has been on each primary-care doctor to encourage their patients to get health screening tests on schedule,” Green stated in the press release. But that isn’t always effective, she observed.
However, Green added, some testing is better than none at all. “The best test for colorectal [cancer] screening is the test the patient will do, and one they’ll keep doing on time,” she concluded.
For pathologists and clinical laboratory managers, this is another example of how researchers are mining the electron health records of patients to produce data that can be used by clinicians to improve healthcare outcomes and reduce costs. At the same time, increased screenings mean increased testing volumes for medical laboratories serving those clinics using these approaches.