Although early cancer detection can lead to improved outcomes, cancer screening tests are often underused. But a research team at the University of Pennsylvania is using electronic health records to change that.

The Penn Medicine specializing in nudges reprogrammed EHRs to prompt medical assistants to set up a screening order for doctors to sign once they see the patient, which had a positive effect on an increase in screening orders.

However, the results of the study also indicated this type of nudge is a two-step process--first the doc, then the patient.

"There were two surprising findings in this study," Dr. Mitesh Patel, director of the Penn Medicine Nudge Unit and an assistant professor of Medicine, as well as the senior author of the study, told Healthcare IT News.

He said the first was how large of an impact these nudges had on clinicians ordering cancer screening, noting there was a 22 percentage point increase in breast cancer screening and 14 percentage point increase in colorectal cancer screen.

These increases mean that 88 percent of the patients due for breast cancer screenings had one ordered – that number was 82 percent for colorectal cancer.

"The second surprise was that despite the large increases, there was no impact on rates of patient completion, indicating that an additional nudge directed to patient is likely needed," he explained.

He said in most cases, patients are left on their own to remember to schedule and complete cancer screening--practices could therefore implement nudges to prompt patients to schedule appointments and remind them to complete the cancer screening.

Patel said the team’s next step is to explore how to best combine the successful doctor nudge with one for patients.

"Decisions on cancer screening used to be kept on pen and paper. Now we can see these decisions in real-time, including who is eligible for screening and when," Patel explained. "This can be linked to nudges at just the right moment to prompt shared decision-making on cancer screening."

The study's lead author, Esther Hsiang, also pointed out mobile technology such as smartphones or tablets could be important in providing nudges to patients, as people are increasingly using their mobile devices to manage many parts of their lives, including their healthcare.

"Nudges to patients could be manifested in the form of push notifications to the devices patients carry in their pocket everyday, which can potentially increase patients’ completion of health maintenance tests," she said.

Hsiang cautioned, however, that the security of mobile technology and apps would need to be appropriately developed to meet important health information privacy requirements, such as those mandated by HIPAA.