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Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing

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Summary

Integrating electronic health record interventions into clinic workflows did not increase colorectal cancer (CRC) screening rates. Patient portals may not reach those most in need, potentially widening health disparities.

Keywords:
colorectal cancer screeninghierarchical generalized linear modelspatient portalsprogram reach

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Area of Science:

  • Health Services Research
  • Preventive Medicine
  • Digital Health

Background:

  • Many individuals do not undergo colorectal cancer (CRC) screening, even after physician recommendation.
  • Electronic health records (EHRs) and patient portals offer opportunities for interventions within clinical workflows.
  • This study evaluated a patient-facing intervention to enhance CRC screening post-physician recommendation.

Purpose of the Study:

  • To assess the effectiveness of an EHR-integrated, patient-facing intervention on CRC screening uptake.
  • To determine if the intervention reached the intended patient population.
  • To explore the role of EHR functionalities in delivering patient-centered cancer screening interventions.

Main Methods:

  • A 2-arm pragmatic randomized clinical trial was conducted.
  • Participants (aged 50-75) received a physician recommendation for CRC screening.
  • Intervention delivery and screening outcomes were tracked using EHR functionalities.

Main Results:

  • 1,825 adults participated; 78% were exposed to the intervention.
  • 65% of participants were screened at follow-up, with no significant difference between study arms.
  • While 75% of contacted patients accessed study materials, the intervention did not significantly improve CRC screening rates.

Conclusions:

  • Integrating patient-facing interventions into EHRs facilitates practice integration but may not improve screening uptake.
  • Portal-based interventions may not effectively reach all patient segments, potentially limiting impact.
  • Relying solely on patient portals for CRC screening interventions may not alter screening behavior and could worsen health disparities.