Personal Electronic Health Records in Improving Screening Rates for Colorectal Cancer

OBJECTIVES:

- To assess whether screening rates for colorectal cancer (CRC) can be substantially
increased among adults in primary care through the use of a personal electronic health
record that provides a link to a validated web-based tool to estimate an individual's
risk of CRC and electronic scheduling of CRC screening exams.

OUTLINE: This is a multicenter study. Participants are stratified according to participating
Harvard Vanguard Medical Associates (HVMA) center. Participants are randomized to 1 of 2
arms.

- Intervention arm: Participants receive an electronic message within their MyHealth
account on behalf of their primary care physician providing a link to a web-based tool
to allow them to assess their personal risk of colorectal cancer (CRC). The tool
provides an estimate of an individual's personal risk of developing different types of
cancer over the next 10 years relative to others of the same age and sex. The tool also
recommends steps that individuals can take to reduce their risk. The tool includes
questions about family history; prior screening tests; dietary habits (red meat,
fruits, and vegetables); weight and height; and use of folate, aspirin, estrogen
therapy, alcohol, and tobacco. In addition, the electronic message provides information
regarding options for CRC screening, emphasizing colonoscopy every 10 years per the
current HVMA guidelines, followed by the secondary recommendation of annual fecal
occult blood testing. Detailed information is provided in the form of a link to online
educational materials. Participants may request either colonoscopy or fecal occult
blood testing by responding to the electronic message and indicating their preference.
Participants who request colonoscopy are contacted by the gastroenterology department
to proceed with CRC screening; participants who request fecal occult blood testing will
receive a stool card test kit in the mail from their primary care physician.

- Control arm: Participants receive no intervention.

DISEASE CHARACTERISTICS:

- Overdue for colorectal cancer screening (identified using automated extracts from the
electronic medical record), as defined by the following criteria:

- No fecal occult blood test within the past 12 months

- No flexible sigmoidoscopy within the past 5 years

- No colonoscopy within the past 10 years

- Receiving primary care at a Harvard Vanguard Medical Associates (HVMA) center

- Registered to use the HVMA patient portal (MyHealth) AND has an active MyHealth
account

PATIENT CHARACTERISTICS:

- Not specified

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics