Increasing Breast Cancer Screening Rates through an Alert System in the Electronic Medical Record
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Objective: To utilize a real time clinical decision support tool, also known as a best practice advisory (BPA) alert, in the electronic medical record (EMR) to facilitate and encourage referral for breast cancer screening. The use of this BPA alert was intended to assist primary care providers in increasing screening mammography referral for the targeted female population, especially the most vulnerable. Design and Sample: Women, 39 to 75 years of age, presenting to primary care clinics for health care. Measures: Initial mammography screening rates with separation of insured and uninsured populations will be compared to the primary endpoint of mammography completion after initiation of the intervention. In addition, adherence to the alert system will be tracked including ordering, acknowledgement, health maintenance adjustment and cancellation. Intervention: The clinical informatics and population health teams worked collaboratively to design the mammography BPA alert. When a woman presented for health care at a primary care clinic, an alert was populated upon initial entry into her EMR for the provider. The alert system would then prompt a discussion between the provider and patient. This included individualized education and recommendations for breast cancer screening guidelines for all women due for mammography. Results: An alert system in the EMR has demonstrated increased provider adherence to breast cancer screening guidelines. Conclusion: A real time clinical decision support tool in the EMR assists providers in achieving increased screening mammography referral. Future work is planned to include an interface within the BPA alert for a direct order process for the uninsured population. In addition, continuing education will be provided for primary care providers in utilization of the BPA alert. This practice change is cost effective and replicable.