August 16, 2018

6 Steps to Building a Successful Incidental Pulmonary Nodule Program

Starting a Lung Cancer and Incidental Pulmonary Nodule Program can be challenging. It requires the right people, the right processes, and the right software. So where do you start?

Find the right lung coordinator and/or navigator

Building a successful lung cancer program starts with finding the right person. The lung nodule coordinator or navigator will need to take on a wide range of tasks and will act as the liaison between the physician and patient. Because of the multiple skills required in this role, a person with an oncology or radiology background is ideal (though not required). Depending on experience, the coordinator or navigator may be able to jump right in and understand the physicians and the complex coordination necessary to track incidental nodule patients. Ideally, this person will have strong communication skills and the ability to put processes into place.

Identify your physician and administrative champions and their roles

Every successful lung program needs to be fully supported by a team of experts who will back the program. We recommend finding support from an administrator, a radiologist, and a pulmonologist. The administrator will support the lung nodule coordinator or navigator and the overall program. The radiologist will be instrumental in developing the incidental nodule pathways responsible for moving a patient to the next steps in the process. The pulmonologist typically will be the first physician to see the patient after the nodule is detected and usually the one to determine if the nodule is suspicious of lung cancer or not. From there, a hospital may choose to have a tumor board or multi-disciplinary group to further evaluate diagnostic and treatment options for patients. In addition to the above-mentioned staff, a thoracic surgeon, a medical oncologist and a radiation oncologist typically participate in these meetings.

Establish workflows early on

There are several processes that are important to establish right away when you start a lung program. First, determine how incidental nodule patients will be flagged and registered to the incidental nodule program. Solutions like EonDirect automate this process by automatically identifying all incidental nodule patients and registering them to the EonDirect dashboard. This is done with no disruption to radiologist workflow and requires no manual task or file build from the CT techs.  Establishing this workflow will ensure all patients are captured properly. Next, think about who is responsible for triaging these patients and communicating next steps with them and their primary care physicians. Typically this is the lung nodule coordinator or navigator and this will be their first interaction with the patient. Finally, develop consent processes for primary care physicians. These processes give the option for their patients to be automatically opted in (or out) of the nodule clinic.  If they opt out, the responsibility is back to the primary care physicians to manage their patient follow-up.  And if they opt-in, their patients are auto-enrolled in the nodule clinic service your hospital is offering. Clearly defining that process early on will go a long way as you build out your lung program.

Create a seamless follow-up process

Patients enrolled in your nodule program need routine follow-up, so it’s important to make it easy to track patients and follow-up exams. This starts by making communication as seamless as possible to both the primary care office and the patient. Four weeks before a patient is due for their next exam they should receive communication about their upcoming exam. Whether it is a letter or a phone call, the communication should be documented and the new exam should be scheduled in the EMR. Whether you use software like EonDirect or other manual mechanisms to track patient follow-up, every exam or missed exam should be tracked.  Any missed exams should be followed with communication attempts to have the patient reschedule.

Use the right software

Your team’s time is one of your most valuable resources. When you start a lung program, you want to make sure everyone is spending their time doing what they do best. And that’s where good software comes in. EonDirect is fast, easy and intuitive and helps cut down on hours of manual data input. Patient demographics and exams populate automatically into Eon from your hospital’s EMR – which drastically reduces the time required to track and manage patients. The radiology report lives in the patient’s EonDirect record so it’s easy to view. Smoking history, nodule characterization, size, location and much more are all captured. EonDirect makes it easy to track follow-up scans or biopsies, and if you also implement a lung cancer screening program, EonDirect allows you to submit to the Lung Cancer Screening Registry with one click. Finally, if you’re in a management role and you’re managing the analytics of your nodule program, EonDirect gives you access to a wide range of up-to-the-minute analytics right at your fingertips. EonDirect is the first software solution designed to manage incidental pulmonary nodules and has been successfully implemented in various IT environments.


Incidental Pulmonary Nodule Program Workflow Process


Promote your program

It’s crucial to make sure that your program is visible and you have the right communication lines open. Start by attending service-line meetings to promote your program. Talk to ED leaders, let them know that you are watching their ED reports and that you are servicing patients that have incidental nodules. Attend radiology meetings and let radiologists know that you will be looking at their reports. Attend Grand Rounds to meet primary care physicians and develop those relationships face-to-face. Finally, get involved in your community. Join local committees, groups, and activities to build relationships and educate people about what you’re doing.

Also, for any lung program to grow, you’ll need a marketing plan. Meet with your primary care physicians regularly. Make sure they know that they can opt-in to the lung program to take care of any patient of theirs that come into the ED with an incidental nodule. Create program packets, a folder with your marketing brochures, your order sets, and your process. Provide a one-page flyer about your program. All of these marketing materials can go a long way in increasing awareness and visibility for your program.

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