P3.11-08 Lung Cancer Screening at an Academic Medical Center: Early Patterns of Practice

Abstract

Lung cancer screening with low dose computed tomography (LDCT) is associated with a reduction in lung cancer mortality. The Center for Medicare and Medicaid Services (CMS) offers coverage for LDCT, indicated for lung cancer screening, if patients are between ages 55 and 77, are a current smoker or former smoker who has quit smoking in the past 15 years, have a greater than 30 pack year smoking history, and shows no signs or symptoms of lung cancer (hemoptysis and/or weightless). Rush University Medical Center has a Best Practice Alert (BPA) in Epic to notify physicians of patients who meet criteria to receive LDCT scans for lung cancer screening. The BPA fires based on patient’s age and documented pack year smoking history. Successful utilization of the BPA relies heavily on accurate smoking documentation. As part of an ongoing project characterizing the population who ultimately undergoes screening, it became evident that a significant number of patients whom may be eligible for screening are missed due to incomplete smoking documentation. These initial findings highlight the need to develop an improved, accurate, and more convenient system to document smoking history. A retrospective chart review was performed, utilizing electronic medical records, for data from October 2015-October 2017. Data was collected on age, gender, and smoking status. Based on this timeframe, data for 50,421 patients from Rush University Medical Center (RUMC) and Rush Oak Park Hospital (ROPH) was analyzed. Age was restricted to 55-77 years to match CMS re-imbursement criteria. Of the 50,421 patient charts analyzed, 2,720 (5%) met eligibility criteria for lung cancer screening based on their documented smoking history. The majority of patients, 38,197 (76%), had incomplete smoking history documentation. Out of the patients with incomplete smoking history documentation, many charts were missing documentation of smoking history in pack year, and/or the number of years it has been since the patient quit smoking. Data identifies a key weakness in electronic health record documentation of smoking history at RUMC and ROPH. Since the BPA for lung cancer screening only triggers with a documented smoking history of greater than 30 pack years, patients who may be eligible for lung cancer screening are not being identified. By advocating for more thorough documentation of patient smoking history, we can optimize use of the BPA and provide patients with better health management.