EHR ‘nudges’ increase clinician ordering of cancer screenings

The University of Pennsylvania Health System programmed a best-practice alert into its electronic health record to automatically prompt medical assistants to either accept or decline a cancer screening order.

The EHR “nudge” implemented at three different Penn primary care practices resulted in a 22 percent increase in screening order rates for breast cancer, compared with practices without the alert. In addition, the colorectal cancer order rate rose by almost 14 percent vs. the other practices.

“An active choice intervention in the electronic health record directed to medical assistants was associated with a significant increase in clinician ordering of breast and colorectal cancer screening tests,” finds a Penn Medicine study published in JAMA Network Open.

Because the intervention was directed only to medical assistants, the study’s authors contend that the EHR nudges reduced the burden on physicians to respond to the alerts, giving them more time to have discussions with their patients about screenings.

“Since EHRs are used by more than 90 percent of physicians, this is a really scalable approach,” says Mitesh Patel, MD, director of Penn Medicine’s Nudge Unit. “It is likely that it could be successful for other types of screening.”

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Nonetheless, the study also discovered that the EHR nudges were not associated with a significant change in patient completion of either cancer screening test during a one-year follow up. In fact, there was almost no change in the rates of patients who actually followed through and completed their screenings.

“Once cancer screening is ordered, the patient still has to take several steps to complete it,” adds Patel. “That includes scheduling an appointment, sometimes conducting prep—such as bowel prep for a colonoscopy—and then going to the appointment. These several steps can add up to high hurdles, especially if patients have lower motivation to begin with. Future interventions should test ways to nudge patients to complete cancer screenings.”

Going forward, Patel is working on developing a new study to nudge patients—as well as clinicians—and to eliminate or alleviate some of the hurdles patients face in completing cancer screenings.

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