Engaging Patients to Enable Interoperable Lung Cancer Decision Support at Scale

Improving shared decision making for lung cancer screening by adapting and disseminating an interoperable clinical decision support tool and patient-facing app has the potential to reduce lung cancer deaths—the leading cause of cancer-related deaths in the United States.

Project Details -
Ongoing

Lung cancer is the leading cause of cancer-related deaths in the United States. A screening test known as low-dose computed tomography (LDCT) can detect lung cancer early and reduce lung cancer deaths among individuals with a history of heavy smoking, but this test requires patients and their doctors to consider the potential benefits and harms that may differ according to each patient’s individual risk profile. Due in part to the complexity of calculating and considering such patient-specific risk profiles in busy clinical settings, less than 10% of eligible patients receive the screening every year.

To address this need, researchers from the University of Utah, the University of Michigan, and the Veterans Administration (VA) developed a shared decision-making tool known as Decision Precision+ (DP+) that analyzes patients’ electronic health records (EHRs) and provides doctors with individually tailored information on the potential benefits and harms of lung cancer screening. DP+ was developed through previous AHRQ-funded research and builds on previous VA-funded research to develop a standalone web-based lung cancer screening shared decision-making tool known as Decision Precision. DP+ uses the Substitutable Medical Applications, Reusable Technologies (SMART) on Fast Healthcare Interoperability Resources (FHIR®) EHR integration framework and helps patients and their doctors make informed, patient-centered decisions regarding this potentially life-saving test. DP+ has been in clinical use at University of Utah Health since 2020, and the rate of lung cancer screening among eligible patients has increased dramatically following the introduction of DP+ and associated provider and patient prompts to consider screening.

This current research will adapt DP+ to include a patient-facing SMART on FHIR application and develop and evaluate an approach for other organizations to implement this application in their own EHR systems.

The specific aims of the research are as follows:

  • Adapt DP+ to include a patient-facing SMART on FHIR app (MyLungHealth).
  • Evaluate the impact of MyLungHealth in a randomized trial.
  • Develop and evaluate a replicable approach for real-world dissemination and implementation of interoperable clinical decision support.

Using a user-centered design approach, the research team will build a patient-facing application called MyLungHealth that integrates with the patient portals of University of Utah Health and NYU Langone Health and can be used directly by patients. MyLungHealth will be “prescribed” to eligible patients so they can learn about lung cancer screening; review, update, and augment their smoking history in the EHR; and review their individualized estimates of benefits and risks. The team will then evaluate the impact of MyLungHealth in a randomized controlled trial across over 100 primary care clinics at University of Utah Health and NYU Langone Health. Lastly, researchers will study how best to help other health systems implement these tools and develop self-service resources to assist with implementation. By doing so, this research will widely disseminate patient-centered tools to help improve lung cancer screening at scale and reduce lung cancer deaths.