Colon cancer screening doubles with use of electronic health records

Researchers used electronic health records (EHRs) to identify patients in a health care cooperative who were not screened regularly for cancer of the colon and rectum, and to encourage them to be screened. This centralized, automated approach doubled these patients' rates of on-time screening and saved health costs over 2 years.

More than one in 20 Americans will develop colorectal cancer, which is second only to lung cancer in causing deaths from cancer. Screening for colorectal cancer is strongly recommended for everyone aged 50 to 75 years, but almost half of Americans do not get screened regularly—far below the screening rates for cervical and breast cancer.

"Screening for colorectal cancer can save lives, by finding cancer early—and even by detecting polyps before cancer starts," said study leader Beverly B. Green, MD, MPH, a family physician at Group Health in Seattle, Washington. "But screening can't help if you don't do it—and do it regularly."

The SOS (Systems of Support to Increase Colorectal Cancer Screening) trial started by identifying 4,675 Group Health patients, aged 50 to 73 years, who were not up-to-date for colorectal cancer screening. Then these patients were randomly assigned to one of four stepped groups.

The first group received usual care, which includes both patients and clinic reminders for those overdue. The second group received this plus automated care, which included a letter telling them they were due for colorectal cancer screening and a pamphlet about screening choices and the pros and cons of recommended screening options. The third group received usual care, automated interventions, and an additional step called assisted care if they still had not completed screening. The fourth group received usual care, automated, the assisted intervention, and an additional step called navigated care if they were still overdue for screening or requested a colonoscopy or sigmoidoscopy during the automated or assisted steps.

Each step of the SOS intervention raised the percentage of patients who were current for colorectal screening for both years: 26% for usual, 51% for automated, 57% for assisted, and 65% for navigated care. This randomized controlled trial was published in Annals of Internal Medicine (2013;158[5Part1]:301-311).

The 2-year costs of the automated intervention plus the screening were actually $89 lower than if the patients had received only usual care. The reason: compared with patients who received usual care, more of those in the automated care group chose fecal occult blood testing (FOBT) instead of sigmoidoscopy or colonoscopy. The kit costs much less than the procedures do.

"Traditionally, the onus has been on each primary-care doctor to encourage their patients to get health screening tests on schedule," Dr. Green said. Group Health pioneered using a centralized registry to remind women to be screened regularly for breast cancer. "We borrowed that approach and applied it to colorectal cancer," she added. "We empowered patients to do testing on time, by giving them options, or sending them a FOBT kit by default if no choice was made."

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