Electronic 'trigger' can identify cancer red flags, reduce diagnostic delays

Electronic "triggers" searching for data within an electronic health record can identify patients at risk of delayed cancer diagnosis and speed up the diagnostic evaluation, according to a new study in the Journal of Clinical Oncology.

Workplace pressures, information overload and other factors can contribute to delays in clinician follow up of abnormal findings that could be indicative of cancer.

For the study, researchers from the Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center conducted a cluster randomized controlled trial of 72 primary care physicians at two sites over a 15 month period in 2011 and 2012.

The physicians were split into an intervention and a control group. The researchers used an algorithm with the intervention group twice a month to look for red flags for prostate, lung and colon cancer, such as iron deficiency anemia, elevated prostate specific antigen and positive fecal occur blood test.     

Of 10,673 patients with abnormal findings, the trigger flagged 11.8 percent at high risk for delayed diagnostic evaluation. The information then was communicated to the physician. The times for a diagnosis evaluation were "significantly" lowered for intervention patients with indicia of prostate and colon cancer; the percentage of patients who received follow up also improved.   

"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," Hardeep Singh, associate professor of medicine at Baylor and chief of health policy, quality & informatics at the DeBakey Veterans Affairs Medical Center, said in a statement.

Other studies have shown the benefits of harnessing the data in EHRs to identify patients at high risk for health problems and to pinpoint diagnostic errors. Improving patient safety has been one of the cornerstones of EHR adoption.

To learn more:
- here's the announcement
- read the abstract

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