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Electronic medical records beneficial during lung cancer screening
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CHICAGO — An electronic medical record-centered database appeared useful in obtaining important quality and outcomes data from patients undergoing lung cancer screening, according to results presented at the International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology.
“We’ve learned the evidence is sufficient for lung cancer screening, but it also involves a shared decision-making visit, smoking cessation and contribution to a national registry. So, we need to develop a quality process,” Cherie P. Erkmen, MD, associate professor of thoracic medicine and surgery and director of the lung cancer screening program at Temple University Hospital, said during her presentation. “Unfortunately, our progress turns into a giant brick wall.”
Twelve percent of primary care physicians are not screening with low-dose CT scan, and 21% are still using chest x-rays, a modality that has “never been proven effective,” Erkmen said. Proper documentation also is needed.
Erkmen and colleagues developed a multidisciplinary structured lung cancer screening program in an urban academic health system. During appointments, the program incorporated shared decision-making, smoking cessation and low-dose CT scan.
Researchers created a mechanism to measure metrics and outcomes using existing functions of 373 patients’ electronic medical records.
“It is very similar to what most of the country is doing now, but we do all the documentation and data entry required by CMS for billing and desired by the community for further understanding,” Erkmen said.
Researchers used a flowsheet function of the Epic electronic medical record system to create custom fields that asked about demographics, smoking status, history of smoking, lung cancer screening eligibility, shared decision-making, smoking cessation counseling and results of low-dose CT screening. Researchers also administered patients follow-up questionnaires.
The population was “very diverse,” Erkmen said. Fifty-one percent were men, 65% were black and 61% were active smokers. Thirty-percent of the population had less than a high school education.
Ninety-eight percent of patients documented a shared decision-making visit and 90% reported using a shared decision-making tool within the flowsheet.
For smoking, 351 patients reported their current status and pack years in the flowsheet. Of these, 228 were active smokers. A total of 221 active smokers reported at least a discussion of smoking cessation counseling.
Two hundred ninety patients reported low-dose CT screening results and 265 reported they completed the postscan questionnaire.
“We were using our existing Epic platform to collect diverse data,” Erkmen said. “We can tailor these data based on what we need; we need more information about race, education and socioeconomic barriers.”
Erkmen emphasized the positive benefits of the database.
“It is within the electronic medical record, so that while we are delivering care, we are also collecting data and ... we don’t have to log off and get into a separate secure database,” she said, adding that it is also the provider, and not someone else, ensuring the quality of data.
“We were able to successfully implement an existing function of Epic to collect data for lung cancer screening,” Erkmen added. – by Melinda Stevens
Reference:
Erkmen CP, et al. Abstract OA01.02. Presented at International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology; Sept. 14-16, 2017; Chicago.
Disclosure: Erkmen reports no relevant financial disclosures.