The Impact of Fluctuations in Pack-Year Smoking History in the Electronic Health Record on Lung Cancer Screening Practices

Objective Health systems could adopt population-level approaches to screening by identifying potential screening candidates from the electronic health record and reaching out to them via the patient portal. However, whether patients would read or act on sent information is unknown. We examined the feasibility of this digital health outreach strategy. Methods We conducted a single-arm pragmatic trial in a large academic health system. An electronic health record algorithm identified primary care patients who were potentially eligible for lung cancer screening (LCS). Identified patients were sent a patient portal invitation to visit a LCS interactive Web site which assessed screening eligibility and included a decision aid. The primary outcome was screening completion. Secondary outcomes included the proportion of patients who read the invitation, visited the interactive Web site, and completed the interactive Web site. Results We sent portal invitations to 1,000 patients. Almost all patients (86%, 862/1,000) read the invitation, 404 (40%) patients visited the interactive Web site, and 349 patients (35%) completed it. Of the 99 patients who were confirmed screening eligible by the Web site, 81 made a screening decision (30% wanted screening, 44% unsure, 26% declined screening), and 22 patients had a chest computed tomography completed. Conclusion The digital outreach strategy reached the majority of patient portal users. While the study focused on LCS, this digital outreach approach could be generalized to other health needs. Given the broad reach and potential low cost of this digital strategy, future research should investigate best practices for implementing the system.

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Identifying Patient Smoking History for Cessation and Lung Cancer Screening through Mining Electronic Health Records

Cancer Epidemiology Biomarkers & Prevention ◽

10.1158/1055-9965.epi-17-0032 ◽

2017 ◽

Vol 26 (3) ◽

pp. 437.1-437

Author(s):

T Onega ◽

EL Nutter ◽

J Sargent ◽

JA Doherty ◽

S Hassanpour

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Electronic Health Records ◽

Lung Cancer Screening ◽

Smoking History ◽

Health Records ◽

Electronic Health

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Extent of implementation of low-dose CT in lung cancer screening.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19177 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19177-e19177

Author(s):

Merin Jose ◽

Rajesh Desai

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

High Risk ◽

Low Dose ◽

Lung Cancer Screening ◽

The United States ◽

Smoking History ◽

Community Clinic ◽

Low Dose Ct ◽

The Impact

e19177 Background: Lung cancer is the leading cause of cancer deaths in the United States with only 15% alive 5 years after diagnosis. In 2013, USPSTF recommended annual screening for LDCT in high risk individuals. Studies had shown a 20% lower mortality (NELSON trial showed significantly lower lung cancer mortality) with LDCT screening. We aimed to assess the extent to which the guideline for lung cancer screening is being adopted in a community clinic. Methods: A retrospective review of electronic medical record of patients aged 55-80 years with no history of lung cancer who visited a primary care provider in a community clinic in New Jersey from October 2014- December 2019 was done. All records with any form of documentation of smoking were identified electronically. The records of those meeting the criteria (30 pack-year smoking history and currently smoking or have quit within the past 15 years) were reviewed manually to check 1) whether they are eligible for screening, 2) if eligible whether low dose CT has been recommended by the provider and 3) once recommended has it been done and followed by the patients. Results: 359 individuals with documented smoking history were identified. Of those 38.8 % (139/359) had a proper documentation (includes both PPD and number of years of smoking) of smoking history based on which high risk individuals could be identified. Of those 37 individuals met the criteria for lung cancer screening. 62% (23/37) had CT chest ordered at some point of time (16.2% for a different indication and the rest for lung cancer screening). Only 52.2% (12/23) of the patients followed the recommendations and got a LDCT done. Among those 50% (6/12) had follow up CT, 50 % (3/6) of those did it on a regular annual basis while the rest 50% (3/6) did it irregularly. 3 patients followed the annual CT screening for lung cancer. Conclusions: Based on these we note that almost half a decade since the recommendation has been established only a small proportion received the care and a still smaller minority followed it. It reflects the dearth of information regarding the guideline among providers and the lack of awareness of the need to follow among patients. This puts forward need for further interventions for implementation of the guidelines at all levels of care for lung cancer prevention. Measures include analyzing the areas of deficiency through questionnaires for patients and providers. Creating awareness on the need for accurate documentation of smoking history and the impact it can have on care delivered. Educating patients about the benefits in health outcome by following the recommendations.

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Cross sectional study to assess the accuracy of electronic health record data to identify patients in need of lung cancer screening

BMC Research Notes ◽

10.1186/s13104-018-3124-0 ◽

2018 ◽

Vol 11 (1) ◽

Cited By ~ 6

Author(s):

Allison M. Cole ◽

Bethann Pflugeisen ◽

Malaika R. Schwartz ◽

Sophie Cain Miller

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Electronic Health Record ◽

Lung Cancer Screening ◽

Cross Sectional Study ◽

Health Record ◽

Sectional Study ◽

Electronic Health Record Data ◽

Cross Sectional ◽

Record Data

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Lung Cancer Screening in Patients with COPD—A Case Report

Medicina ◽

10.3390/medicina55070364 ◽

2019 ◽

Vol 55 (7) ◽

pp. 364

Author(s):

Roxana Amirahmadi ◽

Avnee J. Kumar ◽

Mark Cowan ◽

Janaki Deepak M.B.B.S.

Keyword(s):

Lung Cancer ◽

Case Report ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Smoking History ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Increased Risk ◽

Poor Functional Status ◽

The Impact

We present two cases demonstrating the nuances that must be considered when determining if a patient could benefit from low dose computed tomography (LDCT) lung cancer screening. Our case report discusses the available literature, where it exists, on lung cancer screening with special attention to the impact of chronic obstructive pulmonary disease (COPD), and poor functional status. Patients with COPD and concurrent smoking history are at higher risk of lung cancer and may therefore benefit from lung cancer screening. However, this population is at increased risk for complications related to biopsies and lobar resections. Appropriate interventions other than surgical resection exist for COPD patients with poor pulmonary reserve. Risks and benefits of lung cancer screening are unique to each patient and require shared decision-making.

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Management of a parenteral opioid shortage using ASHP guidelines

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa425 ◽

2021 ◽

Vol 78 (5) ◽

pp. 426-435

Author(s):

Peter Vo ◽

Daniel A Sylvia ◽

Loay Milibari ◽

John Ryan Stackhouse ◽

Paul Szumita ◽

...

Keyword(s):

Electronic Health Record ◽

Drug Product ◽

Health Record ◽

Large Hospital ◽

Hospital Administrators ◽

Utilization Data ◽

Electronic Health ◽

Opioid Medications ◽

American Society ◽

The Impact

Abstract Purpose Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described. Summary In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions. Conclusion A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

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