Preventive Care - Key Activity 7

KEY ACTIVITY #7:

Create and Use Clinician Reminders


 

This key activity involves the following elements of person-centered population-based care: operationalize clinical guidelines; proactive patient outreach and engagement; pre-visit planning and care gap reduction.

Overview

This activity provides guidance on how to develop, configure and use reminders in the electronic health record (EHR) so that clinicians are aware of which patients are eligible for and due for their colorectal cancer, breast cancer and/or cervical cancer screening based on the U.S. Preventive Services Task Force (USPSTF) guidelines. This activity calls for clinician reminders that flag patients at higher risk, as well as patients with likely barriers to screening (e.g., mobility issues, speaking a language other than English, etc.).

While many of the examples for this activity are for colorectal cancer screening, in most cases the same general steps apply to other adult cancer screenings. When the steps need to be customized for breast cancer or cervical cancer screening, we have included specific guidance.

Clinician reminders are one of several tools that members of the care team can use to help ensure they are aware of their patients’ need for colorectal, breast and/or cervical cancer screening and can discuss screening as part of patient encounters or outreach efforts. These reminders can reduce the time needed to identify the preventive services recommended for each patient.

This activity relies on similar capabilities as care gap management, utilizing population views and registries to create patient specific reminders within each patient’s chart. For EHRs that have the capacity to display care gaps, that information can be leveraged to create clinician reminders for patients who might have an upcoming appointment. While that technology is not well developed, information from registries and care gap reports can be utilized to generate lists that enable care team members or other clinical staff the opportunity to create those reminders. Many EHRs are capable of storing next-appointment data that can also be used to differentiate patients who need a clinical reminder versus those who would benefit from outreach.

Other relevant HIT capabilities to support this activity include care guidelines, clinical decision-making support, including patient-facing clinical decision support, and care dashboards and reports.

Action steps and roles

1. Create a flag or alert in the patient record.

Suggested team member(s) responsible: Panel manager or data Analyst and practice staff responsible for the EHR.

At the patient level, ensure that the practice’s electronic health record (EHR) or population health management tool creates a flag or alert to notify the care team of gaps in care related to colorectal cancer, breast cancer and cervical cancer screening using the latest USPSTF recommendations for colorectal cancer and USPSTF or other recommendations for breast cancer and cervical cancer, in accordance with your practice’s cancer screening protocols (see Key Activity 2: Develop or Update the Practice’s Cancer Screening Protocols). These alerts enable the care team to maximize the identification of necessary preventive services related to patient visits.

See also the clinical practice guidelines section earlier in this guide.

This step may involve one or more people from the practice who work on the EHR, if it is not clear if or how the EHR can produce the colorectal cancer, breast cancer and cervical cancer screening care gap reports.

An example of what a patient-level care gap alert may look like is included in Figure 13.

 

FIGURE 13: EXAMPLE POPULATION CARE GAP REPORT ON BREAST, CERVICAL, AND COLORECTAL CANCER SCREENING

Fig 13

2. Configure the EHR alerts.

Suggested team member(s) responsible: Practice staff responsible for the EHR.

Collaborate with the person or team responsible for your EHR to set up automated alerts within the EHR system for patients due for colorectal cancer, breast cancer and/or cervical cancer screening.
Define reminder frequency. Determine the timing and frequency of reminders (e.g., annually, biennially) based on clinical guidelines and patient risk factors.
Work with the care team and the person or team responsible for your EHR to help ensure that the automated alerts are not lost due to the flood of alerts they receive, are provided at the appropriate time, and are in a place or on a screen that is intuitive to the care team.
If possible, the alert also flags those at greater risk (see the USPSTF guidelines) and/or those who likely have barriers to getting screened.

 

3. Make clinician reminders a part of the pre-visit planning process.

Suggested team member(s) responsible: Panel manager.

Work with the clinician and care team to develop ways to ensure these reminders are part of the pre-visit planning process. See Key Activity 8: Refine and Implement a Pre-Visit Planning Process.

 

4. Ensure reminders are updated continuously.

Suggested team member(s) responsible: Panel manager, QI lead and/or their designee.

So that the clinician reminders remain accurate (e.g., don’t show a patient needing a cancer screening that they just had), it is important to ensure a process for updating the EHR records. At a minimum, this should include:

  • The person(s) responsible for doing this.
  • Whether the needed screening was discussed with the patient (yes/no).
  • If the screening was discussed and the patient’s response (e.g., yes, maybe, no, not at this time).
  • The follow-up needed based on this conversation, including the results of any screening.

 

5. Provide ongoing training on creating and using clinician reminders.

Suggested team member(s) responsible: Panel manager and practice staff responsible for the EHR.

Ensure that all members of the care team receive ongoing training on each of the four steps above. This training can be incorporated into huddles and should be part of the orientation for new staff. At a minimum, it should include ensuring that care team members:

  • Know of the reminders and what they mean.
  • Understand where, how and when they will receive them. This should include showing each clinician in the EHR itself and ensuring that this flag or alert is turned on, as well as visual reminders easily accessible to clinicians.
  • Understand the process for updating the EHR to ensure that the reminders are accurate.

 

6. Monitor clinician reminders for accuracy and completeness.

Suggested team member(s) responsible: Panel manager, QI lead and/or their designee.

It is critical to have a feedback loop with the practice’s care team about any real or potential errors in clinician reminders. This might include patients who are eligible for and due for screening for whom a reminder or flag does not appear or patients who have recently been screened for whom the reminder or flag continues to appear. The reminders process should be modified as needed whenever errors are discovered.

 

FIGURE 14: EXAMPLE OF A CLINICIAN REMINDER

Screen Shot 2024 04 05 At 11.56.57 Am

Implementation tips

  • If the practice has successfully implemented clinician reminders in other clinical areas, this can be used as the basis for clinician reminders for cancer screenings.
  • See also Appendix D: Peer Examples and Stories from the Field to learn about how others are implementing this activity.