Augmented Meaningful Use Criteria to Identify Patients Eligible for Lung Cancer Screening

Abstract

Background Lung cancer screening (LCS) with low dose radiation computed tomography saves lives. Despite recent US Preventative Services Task Force draft endorsement of LCS, a minority of patients eligible is screened. Meaningful use is a set of standards for Electronic Health Records (EHR) established by the Centers for Medicare and Medicaid Services and includes reporting of smoking status. We sought to improve rates of LCS among patients treated at our institution by identifying eligible patients using augmented smoking-related meaningful use criteria. Methods We launched a LCS program at our institution, an NCCN cancer center, in January 2013. We developed a “Tobacco Screen”, administered by clinic staff to all adult outpatients every 6 months and entered into the EHR. This contained smoking-related meaningful use criteria, as well as a pack-year calculation and quit date, if applicable. Weekly electronic reports of patients who met eligibility criteria for LCS were generated, and EHR review excluded patients who had a chest CT within 12 months or who were undergoing cancer treatment. We then contacted those patients to review eligibility for LCS and communicated with the primary treating physician regarding the plan for LCS. Results During the first 3 months of the program, 4 patients were enrolled, 2 by physician-referral and 2 by self-referral. We then began to utilize the Tobacco Screen reports and identified 418 patients potentially eligible for LCS. Over the next 7 months, we enrolled a total of 110 patients. 58 (53%) were identified from the Tobacco Screen, 32 (29%) were self-referred, and 20 (18%) were physician referrals. Three stage I lung cancers were detected and treated. The tobacco screen was easily implemented by clinic staff and took a median time of 2 minutes to enter for current and former smokers. Lack of response to attempts at telephone contact and objection to paying out-of-pocket costs were the most common reasons for failing to screen eligible patients. Conclusions Use of augmented meaningful use criteria containing detailed tobacco exposure history is feasible and allows for identification of patients eligible for LCS in a medical center. Barriers to LCS include lack of insurance coverage and lack of systematic referral of patients at high risk.

Perceptions and Utilization of Lung Cancer Screening Among Primary Care Physicians

“…We have previously shown that such a system is feasible and increases LCS utilization. 25 Managed care organizations may also identify patients eligible for LDCT and refer directly to a screening program. Finally, most PCPs refer current smokers to tobacco cessation services, during which identification of patients eligible for lung cancer screening may also be possible.…”

Assessing data availability and quality within an electronic health record system through external validation against an external clinical data source

“…Current practice encourages clinicians to use the ask-advise-connect model [31], determine lung cancer screening eligibility, and go through shared decision making within a visit [32]. However, physicians may not be fully trained on how to complete these processes [33–35], or find that those eligible for services have more pressing concerns that need to be addressed in the limited time clinicians have with patients [36]. Individuals automatically identified as potentially eligible for smoking-related services could be sent shared decision-making paperwork before a clinical visit or referred to tobacco experts for immediate follow up, empowering them to be proactive in preventative and early detection care.…”

The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries

“…Therefore, an optimized and affordable provider education program should be a priority in early implementation phases 62 . In HICs, the use of electronic health records to help identify high-risk individuals also enhanced referral rates, but such a tool is not readily available in most LMIC clinics 66 . Employing community health workers (CHWs) for screening recruitment and counseling has been successful in LMICs 67 and might be a feasible and practical aid to busy clinicians 68 .…”