A new enhancement in Epic helps identify patients at high risk for lung cancer and refer them to smoking cessation and a lung CT scan.
In the ambulatory setting, medical assistants should document a patient’s relevant smoking history, including number of cigarettes per day and how many years they’ve smoked. This documentation occurs in the Rooming tab -> Social History. If a patient is determined to be at high risk for lung cancer, a best practice alert (BPA) will now be triggered for the provider.
Who is considered high risk?
A high-risk patient is a current or former smoker age 55-80 who is asymptomatic for lung cancer and has smoked the equivalent of one pack a day for 30 years (aka “30-pack-year history”). Epic will calculate the pack-year history.
How the BPA works
The BPA will trigger a smartset to allow orders for nicotine replacement therapy, referrals to smoking cessation at the Graf Center for Integrative Medicine, and shared-decision making for a low-dose lung CT scan. (Shared-decision making refers to the face-to-face visit between the patient and primary care provider that includes the benefits and harms of CT lung screening and counseling of tobacco cessation.)
Demonstrated Benefit of Lung Cancer Screening
Low-dose lung CT scans have been shown to reduce mortality by 20% in high-risk patients. “Despite this documented decrease in lung cancer mortality, as evidenced by multiple international trials, the percentage of eligible patients who undergo this examination remains relatively low on a nationwide basis,” says Mark Shapiro, MD, Chief of Radiology. “Building this into Epic will help make it easier and more seamless to provide evidence-based care for our patients.”
Once a patient is due for their follow up, the clinician will be made aware via an In Basket message.