In an effort to increase colorectal cancer screening rates, researchers at a nonprofit health care organization in Seattle wanted to know whether a centralized electronic system to remind patients might do the trick.

Results from the randomized controlled trial were published in the March 5 edition of the Annals of Internal Medicine.

Group Health, which cares for roughly 700,000 people in Washington and Idaho, leveraged electronic health record (EHR) data to identify patients, ranging in age from 50-74, who were not up-to-date with colon cancer screenings and who were not being screened regularly. Results from the study found that both screening rates improved — twice as many people in the cohort got screened — and costs for the health system also decreased.

"People chose to complete the home stool test and did it regularly when we made it easy for them to do so," Dr. Beverly Green, lead author of the study and a family practice doctor at Group Health, told DOTmed News. "Electronic health records can be leveraged to do this efficiently and economically."

No only did the automated intervention cost less, but so did the stool test, which patients chose over the more pricey colonoscopy.

Evidence on the effectiveness of stool tests versus colonoscopies to detect colon cancer is still being studied, but a recent analysis in the New England Journal of Medicine suggests that a stool test may be just as effective as a colonoscopy.

It is also important to note in relation to this study that Group Health is known for being on the cutting edge of health information technology. For example, patients have access to their medical records online, and they can exchange e-mails with doctors and nurses through a secure portal.

In addition to the central registry, study researchers also wanted to know what the marginal benefit would be from adding stepped increases of additional support for the patients who were still not being screened for colon cancer. They used EHR data to automatically mail information on screening and what screening choices were available: colonoscopy, sigmoidoscopy, or stool test (FOBT kit). If no choice was made, patients were sent stool tests in the mail with instructions and a postage-paid return envelope.

"The intervention was unique because it required few resources outside of an accurate electronic health record and computerized mailings and letter sorters," said Green.

The process was repeated for patients in year two as well.

Green said some groups got additional support if they still were not current after the automated mailings. This included assisted care where protocol involved a nurse calling a patient and following up with them about screening options, in addition to helping the patient complete the test if necessary.

"These were effective too, but the magnitude of the increase in screening rates was not as great as that of automated interventions alone and they cost more," said Green.

She added that one caveat with the study involved a special diet for the stool test.

"There are newer tests that are easier to do and have no dietary requirements and screening rates might have been even higher with these," said Green.

Group Health is now using these stool tests that have no diet restrictions for patients.

The study was funded in part by the National Cancer Institute along with Kaiser Center for Health Reasearch Northwest and the Oregon Health Information Network.

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