Abstract C88: Novel use of electronic health records (EHRs) to facilitate free community prostate screening events

Abstract

Abstract Introduction Free screening events, while a valuable means to educate and provide cancer screening for individuals in socioeconomically disadvantaged communities, suffer from a number of limitations including: limited scope, poor patient follow up, and lack of long term tracking of individuals with high risk screening outcomes. The Center for Medicare and Medicaid Services advocates for electronic health records (EHRs) to flag opportunities for “reduction of disparities, research, or outreach.” EHRs represent a potentially powerful tool to assimilate and track individual screening outcomes. However, implementation of electronic health records a to facilitate free screening events such as for prostate cancer has not been reported. Among the barriers to EHR use for free screenings is the requirement to create billable encounters for each patient for whom personal health information is to be entered. Therefore, we reconfigured our EHR to create HIPAA compliant, non-billable encounters for the purposes of entering demographic information, tracking screening results, and generating follow-up letters to participants and their primary care physicians (PCPs) after a free community screening event in an at risk community. Materials & Methods Between 2013 and 2015 our group hosted three annual free prostate cancer community-screening events in the city of New Haven, CT. To facilitate tabulation of demographic information and screening results we prevailed upon our EHR administrators to design workflows to allow for patient registration and patient data capture unique to our screening events that would not be associated with a billable encounter. Providers counseled patients on prostate specific antigen (PSA) testing, ordered testing if appropriate, and performed a digital rectal examination (DRE) for each encounter. Demographic information and DRE results were manually entered into the EHR by a registered nurse for all patients and PSA testing performed by our own hospital-based ancillary service with direct resulting of PSA tests into the EHR. Automatic electronic alerts were generated for all PSA results and were preconfigured to be routed to the MD directing the event and two nurse managers. Results In the most recent screening year, 93 men were screened of whom 27 (29%) were flagged for follow-up: 21 (23%) for abnormal screening results and six for benign urologic issues who requested follow-up with our physicians. Using demographic information entered at the time of registration, 26 of the 27 (96%) participants flagged for follow-up were successfully contacted and only one participant could not be reached for follow-up. Letters to PCPs were successfully transmitted for all participants who had provided PCP information during the intake process. Of 21 participants with abnormal screening, 3 were known to have a preexisting diagnosis of prostate cancer and were actively under the care of a urologist and/or oncologist, 3 had established relationships with urologists and indicated their intent to follow-up with their regular urologist, 9 underwent repeat PSA testing and were offered follow-up with one of our urologists at no cost, 3 were scheduled for MRI of the prostate for further stratification of risk, and 3 were scheduled for prostate biopsy with one of our physicians. All tracking of results, coordination of care, and external communication to participants and their PCPs was executed through the EHR Conclusion The electronic health record when reconfigured to serve as a platform for a community screening event, allows for a novel, secure and multidimensional tool to enhance screening, provide appropriate follow-up, and establish vital long-term relationships with participants. Citation Format: Charles Walker, Meghan Curran, Jay Patel, Beth A. Jones. Novel use of electronic health records (EHRs) to facilitate free community prostate screening events. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C88.