Pathology driven automation to improve updating documented follow up recommendations in the EHR after colonoscopy
Elizabeth R. Stevens, Arielle Nagler, Casey Monina, JaeEun Kwon, Amanda Olesen Wickine, Gary Kalkut, David Ranson, Seth A. Gross, Aasma Shaukat, Adam SzerencsyBackground:
Failure to document colonoscopy follow-up needs post-polypectomy can lead to delayed detection of colorectal cancer (CRC). Automating the update of a unified follow-up date in the electronic health record (EHR) may increase the number of patients with guideline concordant CRC follow-up screening.
Methods:
Prospective pre-post design study of an automated rules-engine-based tool using colonoscopy pathology results to automate updates to documented CRC screening due dates was performed as an operational initiative, deployed enterprise-wide May 2023. Participants were aged 45-75 who received a colonoscopy November 2022 to November 2023. Primary outcome measure is rate of updates to screening due dates and proportion with recommended follow-up <10-years. Multivariable log-binomial regression was performed [relative risk (RR), 95% confidence intervals (95% CIs)].
Results:
Study population included 9,824 standard care and 19,340 intervention participants. Participants had a mean age of 58.6±8.6 years and included 53.4% females, 69.6% non-Hispanic White, 13.5% non-Hispanic Black, 6.5% Asian, and 4.6% Hispanic. Post-intervention, 46.7% of follow-up recommendations were updated by the rules engine. The proportion of patients with a 10-year default follow-up frequency significantly decreased (88.7% to 42.8%, p<0.001). The mean follow-up frequency decreased by 1.9 years (9.3 to 7.4 years, p<0.001). Overall likelihood of an updated follow-up date significantly increased (RR 5.62, 95%CI: 5.30 – 5.95, p<0.001).
Conclusion:
An automated rules-engine-based tool has the potential to increase accuracy of colonoscopy follow-up dates recorded in patient EHR. The results emphasize the opportunity for more automated and integrated solutions for updating and maintaining EHR health maintenance activities.