Impact of an Electronic Health Record Update on Appropriately Scheduled 5-Year Colorectal Cancer-Screening...

Prior studies have shown that colorectal cancer screening/surveillance colonoscopies are performed earlier than guideline-recommended intervals. We implemented an electronic health record (EHR)-based intervention to improve the proportion of appropriate 5-year colonoscopies that are scheduled at a tertiary academic medical center.

This was a single-center pre-post study of patients with a primary care provider at our institution with an active EHR flag for 5-year screening/surveillance colonoscopy due in 2023. We first conducted a chart review of cases scheduled between April 2023 and July 2023 to evaluate indication and appropriateness for 5-year screening based on the US Multi-Society Task Force February 2020 guidelines. Starting at July 2023, if the case was guideline inappropriate, the EHR flag was revised to reflect updated guideline-based recommendations. The postimplementation phase was defined as between October 2023 and January 2024.

Of 17,313 cases scheduled in the 10-month period, 9831 were screening/surveillance colonoscopies. Of the total number of cases, 1746 (10.1%) had a 5-year return flag, with 555 patients in the preimplementation phase, 538 in the transition phase, and 653 in the postimplementation phase. In the preimplementation phase, 69.2% (384/555) were guideline inappropriate, whereas in the postimplementation phase, 56.5% (369/653) were nonguideline. There was a 10.9% increase in appropriately scheduled cases per week after implementation.

This study highlights the effectiveness of an EHR intervention in improving adherence to colorectal cancer-screening protocols. The concomitant decrease in polyp-based guideline-inappropriate cases shows that the intervention reflected updates in polyp guidelines. However, continued efforts are needed to reduce the high proportion of nonguideline cases, to increase capacity for other indicated procedures.