Can an Active Choice Intervention in Electronic Health Records Increase Cancer Screening?

An active choice intervention in the electronic health record (HER) directed to medical assistants was associated with a significant increase in clinician ordering of breast and colorectal cancer screening tests, according to a study published in JAMA Network Open.

This retrospective quality improvement study was comprised of 26,269 women (60.4% white, 29.4% black) eligible for breast or colorectal screening and was conducted at 25 primary care practices at the University of Pennsylvania Health System between September 1, 2014, and August 31, 2017. Data analysis was conducted from January 21 to July 8, 2019. Between 2016 to 2017, three primary care practices at the University of Pennsylvania Health System implemented an active choice intervention in the EHR that prompted medical assistants to inform patients about cancer screening during check-in and template orders for clinicians to review during the visit. The study’s primary endpoint was defined as clinician ordering of cancer screening tests. The secondary outcome was patient completion of cancer screening tests within one year of the primary care visit.

According to the results of the study, breast cancer screening, the intervention was associated with a significant increase in clinician ordering of tests (22.2 percentage points; 95% CI, 17.2-27.6 percentage points; P < .001) but no change in patient completion (0.1 percentage points; 95% CI, −4.0 to 4.3 percentage points; P = .45). For colorectal cancer screening, the intervention was associated with a significant increase in clinician ordering of tests (13.7 percentage points; 95% CI, 8.0-18.9 percentage points; P < .001) but no change in patient completion (1.0 percentage points; 95% CI, −3.2 to 4.6 percentage points; P = .36).

The authors wrote in their conclusion that: “An active choice intervention in the electronic health record directed to medical assistants was associated with a significant increase in clinician ordering of breast and colorectal cancer screening tests. However, it was not associated with a significant change in patient completion of either cancer screening test during a 1-year follow-up.”