Effects of Electronic Health Record–Based Interventions on Cervical Cancer Screening in Adolescents

Abstract

To determine whether the 2011 electronic health record (EHR) changes led to improved compliance with cervical cancer screening and management of abnormal results in adolescent (<21 y) patients. Two EHR prompts were implemented in May 2011. The first is a bright yellow alert that pops up whenever a Pap test is ordered in a patient younger than 21 years, recommending against routine screening. The second was a change in wording of the Pap order form, indicating that if Pap testing is done, human papillomavirus (HPV) testing is not appropriate in this age group. The overall rate of Pap testing decreased after the EHR changes (86/759 [11.3%] before vs 69/1,274 [5.4%] after, p < .0005). The rate of Pap testing without a valid indication such as a 12-month follow-up of previous abnormal results also decreased (66/759 [8.7%] before vs 49/1,274 [3.8%] after, p < .0005). Most Pap tests (77%, both before and after EHR changes) were ordered with reflex HPV testing if atypical squamous cells of undetermined significance. Use of the correct Pap order type (Pap alone, no HPV test) did not improve (16/86 [18.6%] vs 15/69 [22%], p = .0857). These prompts were associated with lower rates of unindicated Pap testing in adolescents but did not improve providers choosing the correct Pap type.