Haywood: EonDirect First Month Use Case

*LungDirect lung screening tracking software is now a part of Eon EPM Solutions


Haywood Regional Medical Center, a 159-bed community hospital in Clyde, North Carolina, is nestled in the Blue Ridge Mountains right outside of Asheville. When Pulmonologist Dr. Scott Skibo joined Duke LifePoint in February 2017, his major focus was to grow the lung screening program and build a pulmonary incidentaloma clinic. In doing so, Haywood screened almost 400 high-risk patients and built a busy nodule clinic. All without a lung screening tracking software to track patients and they soon realized they needed a better solution.


Amanda Franklin, Dr. Skibo’s RRT, received biweekly emails from radiology for some incidentally identified patients and a daily email of the screening low dose CT’s performed. After receiving the list, she would contact both the patient and their PCP to inform them of the findings and recommended follow-up. Amanda tracked patients on a color-coded Excel spreadsheet and used calendar reminders for follow-up, and she reports spending about 20 minutes per patient per touch, with a minimum of 4-5 touches per patient.


Haywood chose LungDirect* lung screening tracking software to streamline patient identification and track the longitudinal care of lung screening and pulmonary incidentaloma patients. “As a profession, the most powerful thing we can do is diagnose lung cancer early. By identifying patients at risk for developing lung cancer, LungDirect* is allowing us to do this in a powerful way. LungDirect* is doing what they said they would, this wasn’t just a whole bunch of words sold to us.”


Within one month of going live with LungDirect*, 23 incidental nodules were identified via LungDirect*’s proprietary dual-mechanism identification process. This represents a significant opportunity for Haywood Regional to diagnose more lung cancer early. Additionally, 396 screening patients’ records were submitted to the ACR via one-click submission, bringing Haywood into complete CMS compliance.


Amanda says compared to the old way of tracking patients, using LungDirect* is “incredibly efficient and easy to use.” She enjoys the fact that she can come in and review screening and incidental patients daily, and that the program is no longer reliant on other staff members to send her a list of patients. Amanda also enjoys the auto-populated letters within LungDirect* and does not miss going into Word to copy and paste patient information.


With LungDirect*, Dr. Skibo and Amanda are seeing greater efficiencies in patient identification and patient management, leading to faster intervention with the ultimate goal of diagnosing Lung Cancer at earlier stages.


Haywood Regional Medical Center EonDirect lung screening tracking software Case Study

Low Dose CT Lung Cancer Screening Benefits and Implementation Challenges

As a physician, I’m always happy when new services can be offered to patients, especially when the benefit includes a 20% reduction in mortality, such as Low Dose CT Lung Cancer Screening. As it is widely known, the National Lung Screening Trial (NLST) conducted a large multi-center study to determine the benefits of screening in a high-risk population for the early detection of lung cancer. The results were promising enough for the trial to end early and CMS to determine lung screening beneficial enough to be covered.  While great news for patients, the CMS requirements have made it difficult for hospitals to implement comprehensive screening programs.


When I started a lung screening program at my former hospital, I realized how difficult it is to properly run a program. Lung cancer screening requires complex patient eligibility requirements to be met, and a convoluted intake process makes it challenging for primary care physicians and hospitals to implement an ACR compliant program.  The end result, we had everyone from compliance to marketing to my clinic staff working to manage our patients and ensure compliance.


The intake process starts with a Shared Decision-Making visit between a patient and an advanced provider, usually their PCP.  Together they review the benefits and the risks, and the provider determines patient eligibility.


However, recent studies indicate there are still several gaps in provider knowledge regarding screening guidelines and reimbursement. Many physicians continue to recommend chest x-ray for lung screening instead of the required low dose CT lung cancer screening (LDCT).


PCPs were also less likely to feel confident in their ability to:


  • identify appropriate patients for lung cancer screening
  • decide the workup of patients with positive LDCT findings, and
  • to believe the recommend yearly screening interval is feasible (https://www.ncbi.nlm.nih.gov/pubmed/28648531)


In addition, CMS requires current smokers receive smoking cessation guidance prior to being screened. Recent research shows smoking cessation has become a discipline in and of itself, and simply telling a patient to stop smoking is no longer sufficient due to the complex physical and psychological aspects of smoking addiction.


Once a patient receives the shared decision making (and smoking cessation guidance if applicable), the PCP refers the patient for a Low Dose CT (LDCT).  Screening facilities must confirm patient eligibility, which requires extensive follow-up to determine the patient is between 55-75, has a 30-pack-year smoking history, and no symptoms of lung cancer. All information must be captured and documented, and eventually submitted to an approved registry,


Ninety percent of all screening patients will show either no sign or very low risk, of lung cancer and must prescribe to a minimum of two additional annual low dose CT lung cancer screening scans to ensure lung cancer does not present. This requires intensive patient follow-up, usually with an assigned FTE tracking these patients. Because EMR’s are not designed to track longitudinal care, Excel spreadsheets and calendar reminders have become the norm in patient tracking, and FTE’s spend over an hour per patient per year with a somewhat high degree of error and cost. In some cases, screening centers only track the initial CT because the resource necessary to track patient follow up is not available.


I am driven by the mission to ensure we manage 100% of patients per evidence-based guidelines, and while lung cancer screening as a benefit to patients is a good start, much work still needs to be done to ensure the right patients are identified and screened.  Hospitals who innovate practical and consistent services, such as centralizing the shared decision making and smoking cessation guidance, or develop systems of communication to ensure the intake process is streamlined, will provide significant value to their community and patients.  This is why I founded Eon EPM and I invite you to join me on the journey to keep it 100.