Study Shows Promise for EHR-Based Algorithm in Reducing Cancer Diagnostic Delays

A trigger built in patient EHRs can avoid follow-up delays in those at risk for developing certain types of cancers, a JCO study shows.

A missed opportunity to follow up on abnormal clinical findings can delay cancer diagnosis, add to patient anxiety, and may even result in poor clinical outcomes. Even with the advantage that electronic health records (EHRs) present, failure to receive, recognize or process patient information can result in delays. Now, a paper published in the Journal of Clinical Oncology claims to have developed a trigger algorithm for EHRs that can avoid these delays.

According to Daniel Murphy, MD, MBA, lead author on the paper, “Triggers can act as safeguards as long as the information about potential delays can be communicated to clinicians taking care of these patients.”

Murphy and his coauthors included 72 primary care providers (PCPs) at 2 different sites in the randomized controlled trial that was conducted over a period of 1 year. The triggers in the EHRs at these sites purported to reduce time to follow-up diagnostic evaluation in patients with potential delays in evaluation for lung, colorectal, or prostate cancer. Interventions included queries of the EHR repositories of the flagged patients who did not have associated follow-up, manual review of triggered records, e-mail communication to PCPs, and phone calls if needed.

Time to diagnostic evaluation was compared between control and intervention groups from among 1256 patients. The authors found that median time to diagnostic evaluation in the intervention group was significantly lower than the control group for both the colorectal trigger group (104 days v 200 days; P<.001) and the prostate trigger group (144 days v 192 days; P<.001) but not for the lung trigger group (65 days v 93 days; P = .59). At the time of final review, a significantly greater number of intervention patients received diagnostic evaluations.

These findings have potential implications for ongoing efforts to improve timeliness of cancer diagnosis and can help health care organizations identify patients at risk for delays, the authors conclude.

Senior author Hardeep Singh, MD, MPH, said, “Missed or delayed diagnoses are among the most common patient safety concerns in outpatient settings, and measuring and reducing them are a high priority. Solutions that harvest and put to use the vast amount of electronic clinical data being collected are essential."