A Randomized Controlled Trial to Improve the Accuracy of Follow-Up Surveillance Time Intervals in the Electronic Health Record After a Colonoscopy for Colorectal Cancer Screening.

Abstract

Electronic health records (EHRs) provide cancer screening reminders to patients and clinicians, but they are not always accurate. Updating the EHR after a colonoscopy for colorectal cancer screening is typically performed manually by the endoscopist when pathology results are available but may be error prone. We evaluated an electronic tool embedded in patient result letters that automatically updated the EHR follow-up time interval after a colonoscopy. A randomized controlled trial of endoscopists from 1 institution who performed colonoscopies on patients undergoing a screening or surveillance colonoscopy. Intervention endoscopists were trained to use the electronic tool in their result letters to patients. Control endoscopists continued with their usual care. The primary outcome was the accuracy of the follow-up surveillance colonoscopy time interval in the EHR compared with the time interval specified in the patient result letter. Overall, 43 endoscopists were randomly assigned to intervention (n = 22) or control (n = 21) groups. Characteristics of patients in the intervention (n = 2,365) and control (n = 1,422) were similar. A result letter was sent to 1,498 (63.3%) intervention and 814 (57.2%) control patients ( P < 0.001). Among all patients sent a result letter, the accuracy of the follow-up colonoscopy surveillance time interval between the result letter and the EHR was significantly higher for the intervention (92.4% vs 76.2%, P < 0.001). Intervention endoscopists were more satisfied with the process of reporting results after a colonoscopy (88.2% vs 60.0%, P = 0.11). For patients undergoing a colonoscopy for colorectal cancer screening, an electronic tool embedded in the result letter that automatically updated the EHR significantly improved the accuracy of the follow-up time interval compared with usual care.