Computerized reminder system drove up colon cancer screening rates

Sep 7 2008

A computerized reminder system used in community-based primary care doctors' offices increased colorectal cancer screening rates by an average of 9 percent, according to a new study from the University of Michigan Health System.

The reminder system, called ClinfoTracker, was developed by family medicine doctors at UMHS to help track and manage primary care. The system encourages doctors and patients to follow guidelines for managing chronic diseases or for prevention screenings.

In the current study, published in the September issue of Medical Care, ClinfoTracker was integrated into 12 primary care practices participating in the Great Lakes Research into Practice Network, a statewide practice-based research network in Michigan.

The system printed reminders for patients who met general guidelines for colorectal cancer screening, based on age and history of prior screening. The reminders went to doctors only for eight of the practices and to doctors and patients for four of the practices.

The study followed the practices for nine months. The researchers found that average screening rates at the beginning of the study were 41.7 percent. By the end of the study, that had jumped to 66.5 percent.

"We felt there was a need to develop a reminder and tracking system that could be generalized in very distinct, diverse practices. We found the ClinfoTracker system could fit relatively easily into routine patient care flow and was easy to implement into a practice," says study author Donald Nease, M.D., associate professor of family medicine at the U-M Medical School and co-creator of ClinfoTracker.

The greatest improvements in screening rates occurred at practices that were more technologically savvy and practices where employees were more adaptable and worked well together.

Initially, ClinfoTracker was developed to help doctors track patients' clinical problems and preventive care over time. The software can also assist with chronic care, such as diabetes testing, as well as with cancer screenings and other routine tests.

Traditionally, doctors have used flow sheets, which are typically on paper, to track problems, testing and screenings.

"That works on the one hand at the individual patient level - if you keep up with it. But you don't have the ability with that kind of system to go any further," Nease says.

A computerized system allows doctors to mark whether a test was completed, ordered, discussed with the patient or refused by the patient. If a test was ordered by not completed, the system can generate a reminder, a call list or mailing list for the doctor or office staff to follow up again.

"It keeps the issue active with that patient," Nease says.

The ClinfoTracker software is being used commercially under the name Cielo Clinic at all five UMHS family medicine clinics, as well as at several other community practices and hospitals in Michigan.

Additional study authors: Mack T. Ruffin IV, M.D., M.P.H., professor of family medicine; Michael S. Klinkman, M.D., M.S., associate professor of family medicine and psychiatry; Masahito Jimbo, M.D., Ph.D., M.P.H., assistant professor of family medicine; Thomas M. Braun, Ph.D., assistant professor of biostatistics; and Jennifer M. Underwood, a student in the U-M School of Social Work.

Funding: National Cancer Institute and the Agency for Healthcare Research and Quality.

Disclosure: The University of Michigan has exclusively licensed the ClinfoTracker software is to Cielo MedSolutions, www.cielomedsolutions.com, an Ann Arbor-based start-up company in which Nease and Klinkman have an equity stake.

Reference: Medical Care, Vol. 46, No. 9, Supplement 1, pp. 568-573