Physician alerts fail to boost VA colorectal cancer screenings

A system at U.S. Veteran Affairs (VA) hospitals that sends electronic reminders to physicians when patients are due for colorectal cancer screening has been ineffective in increasing the number of screenings, according to a new study, published at Journal of Clinical Oncology.

Eight VA hospitals implemented the Oncology Watch system in 2008 to not only boost screening rates but also to provide timely diagnosis and surveillance.

The study looked at screening rates for the two years before it was came online and two years after. It also compared screening rates with the other 121 VA hospitals that did not have the system.

The VA mandated colorectal cancer screenings for all average- and high-risk veterans in 2007, Reuters reported, though the study looked only at average-risk patients age 50 to 64.

Researchers found that hospitals that used Oncology Watch had similar screening rates at hospitals that didn't use the system. At hospitals with Oncology Watch, the screening rate was 38 percent in 2006, 32 percent in 2007, 34 percent in 2009 and 33 percent in 2010. The rate at hospitals without the system wasn't far off at 31 percent in 2006, 30 percent in 2007, 32 percent in 2009 and 31 percent in 2010.

"The main message of this paper is that it takes a lot of money, time and mental resources to implement these sorts of things. And these things are happening all over the place. ... So systems are implemented but rarely evaluated," Marko Simunovic, associate professor of surgery at McMaster University in Hamilton, Ontario, told Reuters.

In an accompanying editorial, Simunovic said, "Although it is disappointing that OncWatch did not improve low screening rates, it is better that stakeholders become aware of this and avoid the costs of perpetuating a health information technology solution that is not addressing its primary purpose. More importantly, the evaluation underlines the need for other interventions or strategies to improve CRC screening rates at all VA sites--and the need for subsequent evaluation of such efforts."

The study authors cited alert fatigue among the possible reasons that the alerts failed to produce more screenings. Though they say alerts interrupt physician work flow, vendors and researchers are working to find effective ways to manage the many alerts doctors receive.

The National Cancer Institute is focusing on electronic medical records as a means to improve cancer screening around the nation through its PROSPR (Population-based Research Optimizing Screening through Personal Regimens) sites. It hopes to improve screening for breast, cervical and colorectal cancers at 12 centers.

To learn more:
- read the abstract
- here's the Reuters story
- check out the editorial

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