November is lung cancer awareness month and an annual reminder of the life-saving benefits of a low-dose computed tomography (LDCT) scan which can detect lung cancer early when it’s often curable. Given the high mortality rate of patients who are diagnosed with lung cancer in advanced stages, patient engagement is critical to improving health outcomes for patients at risk of the disease. Unfortunately, few patients who are eligible for a lung cancer screening actually get screened.
Unlike breast, cervical, and colorectal cancer screening rates that dropped significantly since the start of the COVID-19 pandemic, lung cancer screening rates have remained the same. However, researchers believe that’s because screening rates are already abysmally low for the disease. The low screening rates can be attributed to a variety of challenges, from complex eligibility criteria to the stigma associated with cigarette smoking—the leading cause of lung cancer.
Since getting a lung cancer screening is the best way to catch lung cancer early when it’s more easily treated, healthcare stakeholders are invested in finding innovative patient engagement strategies to drive better outcomes for at-risk patients. One of the ways health systems across the country are connecting with eligible patients is by using electronic health records (EHRs), like Epic, as patient engagement tools. Through EHR integrations and workflows, health systems and healthcare providers are seeing improved screening rates by:
- Enabling workflows to alert clinicians to collect thorough smoking history
- Identifying screening-eligible patients using EHR queries
- Delivering patient education using targeted and automated texting based on segmented EHR data
- Facilitating the shared healthcare decision-making process through automated text messages
Using EHR workflows to address the smoking history assessment barrier.
Providers cannot engage patients in preventive care for lung cancer unless patients meet certain criteria gathered through a proper survey of a patient’s medical history. One of the major challenges contributing to screening rates is inadequate assessments of patients’ smoking history which helps to identify eligible populations. In a 2020 study, an internal medicine clinic in Washington, D.C. piloted a clinical print-out given to each provider from the medical assistants to remind clinicians to take a detailed smoking history for every patient. After three months, the intervention increased smoking history documentation by 62 percent. In addition, those who were eligible for lung cancer screening increased by 105 percent. The clinic aims to incorporate this intervention into their EHR to address the barrier of collecting smoking history across the health system. Identifying eligible patients is the first step to determining who to begin actively engaging. Eligibility recently changed, as the U.S. Preventive Services Task Force (USPSTF) adjusted the following screening criteria:
- The task force recommends that clinicians begin lung cancer screenings in patients age 50 rather than 55.
- The USPSTF reduced the pack-years of smoking history from 30 to 20.
An international healthcare organization leverages text messaging to improve patient engagement among those eligible for screening.
In late 2020, CHRISTUS Health, a faith-based healthcare organization headquartered in Texas launched a campaign to help eligible patients receive lung cancer screenings to diagnose and treat the disease while it’s in early stages and most likely to be cured. In partnership with Providertech, the goal is to scale communication to eligible patients who have not yet completed lung cancer screenings, while also engaging patients in their long-term lung health.
Together, we established an automated workflow to identify screening-eligible population segments through our integration with their EHR, Epic. Using Providertech’s HIPAA compliant text messaging platform, the not-for-profit system collaborated with our clinical team to design customized messaging protocols tailored to patients meeting specific criteria such as age, risk factors, location, last visit date, and more. Initially, CHRISTUS began actively engaging patients by inviting them to learn more about why screening was recommended for them by scheduling a shared decision-making visit. During this appointment, lung specialists establish a relationship with the patients, which is critical for both short-term outcomes—like screening engagement—as well as long-term health, such as support for smoking cessation. The appointment is also helpful for routing patients who are already experiencing lung cancer symptoms to the appropriate point of care for further examination.
Chief of Pulmonary Medicine at CHRISTUS Trinity Clinic Dr. Suman Sinha explains, “This population health strategy has significantly increased the number of patients we can establish relationships with, given the high response rate that results in a shared decision-making visit. At this visit, we can help patients understand the value of both getting screened for lung cancer as well as exploring smoking cessation options, which can greatly improve outcomes for patients who are diagnosed with lung cancer.”
After the visit, CHRISTUS continued to promote positive patient behavior by delivering targeted messaging based on the patient eligibility, regularly engaging patients via text, and navigating those eligible patients to schedule and complete their screening CT. The targeted messages included sending additional reminders and educational resources related to the value of lung cancer screening for the message recipient. Despite the pilot outreach being delayed throughout much of the COVID-19 pandemic, several patients were diagnosed with early-stage lung cancer within weeks, allowing them to receive treatment while it is most effective. “Enhancing the lung cancer screening program with secure messaging has already proven to be life-saving,” adds Dr. Sinha.
Improving patient engagement and health outcomes for “non-responsive” patients.
Nearly a year later, CHRISTUS and Providertech resumed communication aimed to increase patient engagement for those eligible for lung cancer screenings. Given the concern of seeking in-office medical care at the height of the pandemic, nearly 400 patients did not interact with the initial text messages. CHRISTUS and Providertech launched text message outreach to encourage these “non-responders” to consider a shared decision-making visit, and the response was overwhelmingly positive. Nearly 20 percent of recipients categorized as “non-responsive” did in fact respond, and of those, nearly 75 percent expressed interest in an initial visit to discuss their eligibility. As of July 2021, four lung cancer screenings had been scheduled, with 29 additional patients in the process.
Increased patient engagement for lung cancer screenings could save as many as 10,000 lung cancer deaths every year.
Lung cancer screenings are critical to catching the disease early, as early detection can improve survival rates by up to 20 percent. But patient engagement among eligible patients requires relationship-building strategies that enable providers and patients to discuss the risks and benefits. EHR workflows and integrations can be leveraged to identify patients eligible for a screening and begin engaging them in the life-saving conversation.
To learn more about patient engagement tools that integrate into your EHR, contact us today.
