Electronic health records improve colon cancer screening rates

Centralized record-keeping systems may help improve rates of colon cancer screening, according to a new study.

Researchers at the Group Health Cooperative, a non-profit health care and insurance system in Washington state, used electronic health records to identify and monitor almost 5,000 patients who were due for a colon cancer screening but hadn't gotten it.

One group of patients received "normal care" - reminders from their doctor during appointments. A second group received a letter in the mail encouraging them to get screened; a third group got a call from a medical assistant on top of all of that, and a fourth group got a "patient navigator" to manage the screening process.

Each additional step increased the percentage of people who got screened, from 26% in the "normal" group to 65% in the patient navigator group.

"With a simple centralized program, we leveraged our electronic health records to identify those who needed screening," said Dr. Beverly Green, the lead study author and a practicing family physician at GHC. "We doubled the colon cancer screening rates."

Traditionally, Green says, colon cancer screening rates are much lower than with other cancers - namely breast and cervical cancers - largely because of one major factor: Convenience.

"You have to take off a day of work, maybe two. The prep is uncomfortable. You have to have somebody to drive you," said Green. "People don't like the idea of (colonoscopies); they're fearful of it."

But she said, colonoscopy wasn't the only screening option offered.

"While [patients are] mustering up their strength to have a colonoscopy, 5 years have passed, and in that period of time, they could be doing a stool card."

A stool card - also known as a Fecal Occult Blood Test (FOBT) - involves putting a small stool sample on a card and mailing it into a lab, where technicians look for trace amounts of blood.

Current U.S. Preventative Services Task Force recommendations say patients should do either a stool card each year, beginning at age 50; a flexible sigmoidoscopy every 5 years along with stool testing, or a colonoscopy every 10 years.

One major criticism of the study is that, although researchers were able to double screening rates, the number of colonoscopies - considered the most sensitive screening tool - actually went down.

"A lot more people did get screened," Green says, "but a few people, because we sent them a stool card, did that in place of a colonoscopy."

And she says while a stool card isn't as effective as a colonoscopy - it'll catch 75% of colon cancers, but very few, if any, pre-cancerous lesions - some testing is better than no testing.

"The best test for colorectal [cancer] screening is the test the patient will do, and one they'll keep doing on time."