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Colorectal Cancer (CRC) Screening Work Flow
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EHR Report   |   EHR Workflow Reminders   |   Call Patient to Discuss CRC Screening   |   Decision Stage and Messaging   |   Screening Options
 

EHR Report

Your EHR makes it easy to run a report at the beginning of each month to determine all your patients eligible for CRC screens. You can customize the report to include patient name, phone numbers, due date of next CRC screen or date and type of last CRC screen and date of next office visit. Once you determine which patients are eligible for a screening, you can determine the next steps, such as a phone call to discuss screening options or a letter.

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EHR Workflow Reminders

Your EHR is a valuable tool to help you increase CRC screening. Below are some suggestions on effectively using your EHR to generate clinical reminders and prompts at the point of care when preventive services are due, track lab orders and test results and more.

Order tracking

Interventions through the EHR can help you track outstanding lab results (such as FOBT/FIT cards), notify patients of their results, document patient notification, and document follow-up on abnormal results when they occur. If the system has integrated orders and labs, the system will indicate “ordered but not received” or “awaiting physician review.” Some EHR vendors use order tracking, which gives the provider access to highlight orders, review results, add memos, and forward to clinic staff. Clinic staff identifies highlighted orders, reviews the provider memo, calls the patient, and adds addendums/documentations as needed to document the patient contact. If the staff was unable to speak to the patient, they can then set a status such as “hold for review” that will keep this patient’s needed follow-up in their work queue.

Alerts and Reminders

Health maintenance alerts and reminders can be intimidating. We recommend you take a slow and steady approach. Each EHR vendor varies as to the way that these are set up. For instance, a reminder or an alert may be set up in the EHR with specific parameters, which would need to be defined. Keep in mind that EHR alerts and reminders are an advanced portion of the EHR known as decision support tools.

Health maintenance alerts and reminders give you an opportunity to catch patients that might have fallen through the cracks. You can establish parameters for these alerts and reminders based on demographics, age, disease and/or medication data. When the patient’s EHR is opened you will receive an alert or reminder based on these predetermined criteria. A specific order can be attached to an alert that you may potentially want to execute. Each vendor is different, but many have similar functionality related to alerts and reminders.

Some EHRs may refer to these alerts and reminders as “chart prompts.” Examples of chart prompts include problem lists, screening schedules, integrated summaries, electronic reminders, and alerts. Each EHR should include Preventive Services or the equivalent within the EHR, generally in a health maintenance or equivalent module.

Patients with increased risk for colon cancer should have this problem included on the problem list. As a point of workflow, it is important to identify which staff member will have the primary responsibility to manage the problem list. However, patient management should be a team approach and all staff has a responsibility to keep the problem list up-to-date.

Scribes

Scribes have been very useful especially for physicians who are struggling with electronic documentation within an EHR. A scribe is usually a non-physician, such as medical student, nurse practitioner, physician’s assistant, or one of any number of new positions being created in vo-technical programs around the country to do this specific type of work. The scribe follows the physician through each visit and enters the data into the EHR while the provider dictates aloud their findings as they are performing their hands-on examination. Once the data is entered, the provider reviews the data entry, makes any edits necessary and signs off on the documentation. This process may help increase productivity freeing up time required for data entry for more patient visits.

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Call Patient to Discuss CRC Screening

Assign a staff person responsibility to call patients you identified as due for screening. These sample scripts (PDF) will help you determine your patients' understanding of CRC screening and to introduce the topic.

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Decision Stage and Messaging

Patient-centered care means understanding each patients' attitudes and preferences toward screening and identifying his or her stage in the decision process. Once you determine the decision stage, you can help move your patient forward with appropriate messaging. To help guide this process, click here for a decision-stage tool. (PDF)

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Screening Options

You have made the decision as to which screening option is best based on your patient's preferences, insurance coverage and risk factors. Now move forward with scheduling a colonoscopy or providing tests in advance of an appointment. Mailing the tests in advance soon after your phone conversation, with instructions to return it at appointment time, will increase the likelihood of it being completed. You will also save time if you prepare the chart with this information prior to the patient visit.

Here are some sample letters and instruction sheets you can mail with the appropriate test.

Letters:

Patient Letters (Includes FIT and FOBT Instructions, Positive or Negative FOBT and FIT Results, Missed Appointment and Return Kit Reminder) (PDF)

Instructions:

Note: Sample instructions for CRC tests are provided as examples only and any reference to a particular brand should not be construed as endorsement of a product by CDPH or any of its affiliates.

 

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Last modified on: 1/8/2014 3:12 PM