Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study

Abstract

Background Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. Objective This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Methods Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. Results A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Conclusions Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment.