Mortality Benefit of Lung Screening

THE BENEFITS OF LOW DOSE CT LUNG CANCER SCREENING

 

Lung cancer is the leading cause of cancer death among both men and women. In fact, more people die each year from lung cancer than colon, breast, prostate and pancreatic cancer combined. And although many improvements in diagnosis, staging and treatment have been made, long-term lung cancer survival rates remain extremely poor.

 

The major risk factors, on the other hand, are well known. 90% of all lung cancer can be attributed to smoking. That means in the U.S., an estimated 94 million current or former smokers have an increased risk for the disease. The huge size of this at-risk group is a major reason why there have been many efforts to find and develop an effective low dose computed tomography (CT) lung cancer screening test over the past several years.

 

Recent Advances in Low Dose CT Lung Cancer Screening

 

In the past, efforts to identify an effective screening test have been unsuccessful. Specifically, several randomized screening trials were able to detect early-stage lung cancer, but were inconclusive in showing a mortality benefit from such screening. However, recent advances in multidetector computed tomography have allowed screening studies using low dose CT scan (LDCT) to be performed. With these tests, patients are exposed to acceptable levels of radiation and only need to hold a single breath. The low radiation dose preserves the detection of focal lung lesions because of the inherently high contrast between aerated lung and soft tissue.

 

National Lung Screening Trial (NLST)

 

The question the NLST set out to answer was whether low dose CT lung cancer screening would reduce mortality from lung cancer for high-risk individuals. The NLST focused on screening people 55 to 74 years old who have cigarette smoking histories of 30 or more pack-years, and who, if they are former smokers, have quit within the last 15 years.

 

The initial NLST found that screening with low dose CT scan reduces mortality by 20% and all-cause mortality by 6.7%.


NLST Results (excerpt)
Lung cancer mortality reduction: 20%
(95% confidence interval [CI], 6.8–26.7; P = .004)


All-cause mortality reduction: 6.7%
(95% CI, 1.2–13.5; P = .02)


Study Design: Evidence obtained from a randomized controlled trial.
Internal Validity: Good


Consistency: Not applicable (N/A) – one randomized trial to date.
External Validity: Fair

 

With these results, the NLST trial is the first randomized screening trial for lung cancer to have shown improvements in both disease-specific and all-cause mortality.

 

Conclusion

 

Despite being the number one cause of cancer death, lung cancer isn’t the most heavily researched. In fact, federal funding for lung cancer research is relatively small compared with funding for other major cancers. That’s why, with this clear conclusion that low dose CT lung cancer screening reduces mortality by up to 20%, the NLST is a major step forward in the advancement of more effective lung cancer screening programs. By increasing detection of this potentially curable disease, low dose CT lung cancer screening can drastically change lung cancer examination and management for hospitals and patients across the country.

 

Eon’s EPM Solution for Lung Cancer Screening helps lung programs across the U.S. screen eligible patients and provide guideline-based next steps for high-risk patients. Eon also offers a white paper on the early detection of lung cancer.

 

References

 

Gutierrez A, Suh R, Abtin F, Genshaft S, Brown K. Lung Cancer Screening. NCBI Website. Accessed October 16, 2018.

 

Lung Cancer Screening (PDQ) – Health Professional Version. National Cancer Institute Website. Accessed October 16, 2018.

EonCast: Candace Cole from Penn Highlands Healthcare discusses how EonDirect has significantly improved their productivity in Lung Cancer screening management

Candace Cole, RN BSN MPM OCN NCTTP is a Nurse Navigator at Penn Highlands Healthcare. In this EonCast, Candy discusses how EonDirect has significantly improved the productivity in their Lung Cancer screening management program by efficiently identifying exams at the time they were performed and registering them to her dashboard to track appropriate follow-up care.

 

Transcript

Danielle Stackrow (Eon):
Hi everyone, it’s Danielle from Eon and we’re doing another EonCast video chat. Today we have Candy and I’ll pass it over to Candy and she’ll introduce herself.

Candace “Candy” Cole (Penn Highlands Healthcare):
Hi, my name is Candy Cole, I’m a nurse navigator for lung cancer screening at Penn Highlands healthcare. Penn Highlands healthcare is a four system hospital in central Pennsylvania and we started our lung cancer screening program in 2015. My responsibilities are all the lung cancer screening patients navigation and smoking cessation.

Danielle Stackrow (Eon):
Awesome, thank you so much, Candy. You have a substantial amount of patients in your EonDirect dashboard, there’s over 1,300 patients in that dashboard. How is EonDirect really helping you manage all of those lung cancer screening patients?

Candace “Candy” Cole (Penn Highlands Healthcare):
It has been quite the advantage working with the EonDirect. EonDirect has helped with the volume of patients, one campus of 1,300 and altogether I have over 3,000 lung cancer screening patients. We’ll be adding the other campuses as I get better with the system. It has helped us with quality and patient management. Before when I didn’t have a tracking system I didn’t always know if a patient came in-between their annual screening and I couldn’t always track properly when their next lung cancer screening was due. EonDirect has really helped with that because of the software system and the way it listens in radiology. When my lung cancer screening patients come in and the scanner goes over their chest those results come into my dashboard. With EonDirect I’m able to see exactly what’s going on with the patient and keep all information current. Whereas before the American College of Radiology required I look at that patient a year later to catch up all that data. Now I work in real time and I’m able to do things that need to be done immediately. EonDirect is really improving the quality of our patient care.

Danielle Stackrow (Eon):
That’s exactly what EonDirect strives for, to change your previous workflow to this new workflow. This software allows you to work in real time. You know exactly when the patient comes in for an annual exam because it’s being registered to your dashboard. All that information is being identified and populated for you to submit to the American College of Radiology and the Lung Cancer Screening Registry (LCSR). I think that’s also been helpful.

Candace “Candy” Cole (Penn Highlands Healthcare):
One other thing I’d like to add and I don’t know if other hospitals have the same problem, when a patient doesn’t show up or they reschedule. Sometimes it’s just rescheduling but I wouldn’t know and I have too many patients to call to asked what happened. With EonDirect no one is lost. Before lung cancer screening patients would reschedule a couple times for a Low dose CT and I used to not find them until they were due again.

Danielle Stackrow (Eon):
I think that EonDirect significantly helps the overall picture.  It helps to identify if the pulmonary nodule has grown which you’re actually getting, like you said in “real-time” with every single patient. I really think it’s making a difference with your workflow and I’m really glad to hear that. You’re only at one campus right now and as we continue to grow and you get more comfortable with the software, we’ll be introducing your other campuses. You’ll be managing easily over 3,000 patients, which will be exciting!

Candace “Candy” Cole (Penn Highlands Healthcare):
I am looking forward to that!

Danielle Stackrow (Eon):
That’s awesome! You’ve kind of touched on this but is there a specific feature that you really love that helps your workflow with these lung cancer screening patients?

Candace “Candy” Cole (Penn Highlands Healthcare):
Yeah, there are two I want to say. First, I like the way the software picks up once my patients get screened and if anything else is done. I’m going to see the information on my dashboard and I’m going to know exactly what’s going on. It’s excellent the way it organizes that information . Second, I like the tumor registry because I can keep track of all my patients that have gone on to be diagnosed with lung cancer, so I really like that feature also.

Danielle Stackrow (Eon):
Yes, I think that’s great because you can continue to track the patient once they have been diagnosed with cancer. You can track their post diagnosis care and have the continued information from the very beginning. For example a patient has been identified with a nodule and EonDirect is there every single step of the way so nothing gets lost during that process. That’s a great feature to touch on and I’m glad that you find that so beneficial for your workflow.

Lastly, what has it been like to work with EonDirect through this process specifically with transitioning from your old workflow to this new workflow.

Candace “Candy” Cole (Penn Highlands Healthcare):
I would really like to commend all the professionals. We started with EonDirect when they were Lungdirect. Before choosing EonDirect I worked with a lot of representatives and a lot of people selling a product or a system and we selected LungDirect (EonDirect) because I found that it was a system that I understood. You’ve got pulmonologists involved, all the other systems we looked at used the mammography model. We weren’t speaking the same language, yet they were trying to sell us the system. That was very frustrating for me, so from day one when I engaged with EonHealth EonDirect, we were speaking the same language. They understood our needs and what I found every step of the way was they’re customer service oriented. I don’t know how they do it 24/7, I work at crazy hours of the night because that’s when I have time to catch up on my data. I hit the chat ask the questions and somebody gets back to me. I have found them to be just wonderful with any type of issue. They will say if they’ve never had the issue, if they don’t know what to do, they’ll figure it out and get back to me which they always do. I appreciate that, I feel like everyone is very responsive and is nice to work with. They are a whole group of professionals that do not get defensive and they are really trying to listen. They even put some things in place for customization that we really needed and more importantly they said “okay, we’ll make that happen”.

Danielle Stackrow (Eon):
I want you to know that we appreciate all the work that you do. Like you said you work “crazy hours” and there have been times where I’m eating dinner and I get a chat from you. I respond, “Hi Candy, how’s it going?”! We at EonDirect think it’s great because we build these amazing relationships with our customers. Like you said we take into consideration if a button isn’t working for you and we’ll try to find a fix for it.  We want to make sure that you’re getting everything you should be getting out of this software. At the end of the day it’s all about working with these patients and making sure they are being identified properly while using the software as it was intended. So, I’m really glad that you had such a positive experience working with Christine, Aki and everyone else on our team. We also really enjoy working with you and everyone else part of Penn Highlands, so thank you so much!

Candace “Candy” Cole (Penn Highlands Healthcare):
Thank you!

How To Report S-modifiers And C-modifiers In Lung Cancer Screening

Incidental findings are common in lung cancer screenings with chest CT. However, reporting of the S-modifier or C-modifier within the Lung-RADs is often inconsistent. Below are some specific guidelines in order to improve reporting consistency and better define potential abnormalities.

 

Background On The Lung-RADS Reporting System

 

The American College of Radiology recommends using their Lung-RADS reporting system. When using this system, moderate to severe pulmonary calcifications must be reported as separate data points. The system requires radiologists to describe their findings on a 0–4 scale, along with a description of the lung nodules and their management. There are two additional categories: the “S” modifier, which is used to describe any “clinically significant or potentially significant findings,” and the “C” modifier, which is used if there is a prior history of lung cancer.

 

Confusion With The S-Modifier

 

The Lung-RADS reporting system defines the category “S” as occurring when a baseline screening reveals, “Other findings (non-lung cancer).” In this case, the “S,” “May add on to category 0–4.” The system defines category “1S” as occurring when a baseline screening reveals, “No nodules or nodules with calcification with other findings (non-lung cancer).”

 

The problem and potential confusion with these definitions are that the terminology “non-lung-cancer-related” is subject to interpretation and may not be used consistently.

 

To better understand this confusion and its potential reporting issues, a retrospective investigation was performed by the Stony Brook University Medical Center, which included 581 individuals who received a baseline low-dose chest CT for lung cancer screening. The study found that initially, “A total of 261 (45%) participants received the Lung-RADS S modifier on baseline CT with 369 incidental findings indicated as potentially clinically significant.” However, after investigation, “an additional 141 incidentalomas of the same types as these 369 findings were described in reports but were not labeled with the S modifier. Therefore, as high as 69% (402 of 581) of participants could have received the S modifier if reporting was uniform.”

 

How To Report Modifiers In A Radiology Report

 

Because of the potential confusion mentioned above, it is important to use as specific detail as possible. To improve accuracy and consistency below is an example of how we recommend reporting modifiers in a radiology report.

 

C Modifier

 

Prior history of lung cancer; CT exam result modifier C.

 

Select one:

N – No

Y – Yes

U – Unknown

 

S Modifier

Other clinically significant or potentially significant abnormalities; CT exam result modifier S.

Select one:

N – No

Y – Yes

 

If yes, what were the other findings?

 

Select all that apply:

0 – Aortic aneurysm

1 – Coronary arterial calcification moderate or severe

2 – Pulmonary fibrosis

3 – Mass (check neck, mediastinum, liver, kidneys, other)

4 – Other interstitial lung diseases

 

Why Reporting Consistency Matters

 

As screening becomes more widespread, accurate data registries will allow for additional efficiencies and improvements in the screening process. Also, reporting consistency will help fuel the advancement of a wide range of computer analytical tools that will provide information beyond just the early detection of lung cancer. Additionally, tracking other clinically significant findings showed an overall mortality benefit in the National Lung Screening Trial (NLST).

 

Eon’s EPM Solution for Lung Cancer Screening uses the Lung-RADS guidelines to help lung cancer screening programs determine next steps for all eligible patients. Eon’s EPM Solution for Incidental Pulmonary Nodules (IPN) helps identify, track and manage patients with IPNs based on the Fleischner Society guidelines. Together, Eon can provide an integrated solution for a comprehensive lung program.

 

References

 

Yankelevitz D, Henschke C. Advancing and Sharing The Knowledge Base of CT Screening For Lung Cancer. NCBI Website. Accessed September 16, 2018.

 

Mehta H, Mohammed TL, Jantz M. Reclassify Lung-RADS Category “S”. Chest Journal Website. Accessed September 16, 2018.

 

Reiter MJ, Nemesure A, Madu E, Reagan L, Plank A. Frequency and Distribution of Incidental Findings Deemed Appropriate for S Modifier Designation on Low-Dose CT in a Lung Cancer Screening Program. NCBI Website. Accessed September 16, 2018.

EonCast: Amanda Franklin from Haywood Medical Center shares how EonDirect has greatly improved her patient management workflow

In this EonCast, Registered Respiratory Therapist Amanda Franklin from Haywood Medical Center shares how EonDirect has greatly improved her patient management workflow and increased the identification of at-risk patients.

 

Transcript

Danielle Stackrow (Eon):
Hi everyone, I’m Danielle and I’m an application specialist here at Eon and so today we’re going to be talking with one of our users just to see her perspective and learn what she’s doing in the application and how much she hopefully enjoys it and her experience with EonDirect.

And so today we’re going to be speaking with Amanda from Haywood and they’re located in North Carolina. So, Amanda tell us just a little bit about yourself and how long you’ve been using the application.

Amanda Franklin (Haywood Medical Center):
Ok. Of course I am from North Carolina as you mentioned. I was born and raised here. We started using LungDirect which is now EonDirect, January of this year (2018). And we transferred over to using EonDirect to track our incidental nodules and lung cancer screening patients, which has been a lifesaver and then on it has been tracking our patients and keeping up with those, so it most definitely helped with our clinic and management

Danielle Stackrow (Eon):
That’s great to hear and I think that’s not only at your Center but also to many others as well and so since you’ve been using it you know for quite a while what is one of your really favorite features within Eondirect.

Amanda Franklin (Haywood Medical Center):
All the features are pretty much great but I think the ACR submissions is, of course, is fantastic. Previously I was not doing those submissions, a manager for our radiology department with from what I seen and she spoke of it was pretty in-depth. I think it took a lot of time. Now that we have EonDirect and we have that capability to just click a button and submit them all is definitely a lifesaver. And then, of course, it allows us to type the patient better I can put reminders in for patients that I want to keep close eyes on and keep track of all the testing that they had done and things like that.

Danielle Stackrow (Eon):
I think that’s great and you are like always on top of navigating and really following up on all of those patients that have been identified and registered to your dashboard in your incoming bucket. And the incoming bucket refers to the patients that have been identified and registered to your dashboard and you are always on top of it and always go in and add those patients who need to be followed through with additional care and I know every time I go on there’s zero patients in that pocket which is great, it makes my job a lot easier which it’s fantastic and then there’s also always zero patients in the incomplete bucket and the incomplete bucket refers to if there needs to be more data entered for whether or not that needs to be more data for the lung cancer registry or more data for incidental patients and Amanda is fantastic and always making sure those patients have all of the data up-to-date for those patients because like she said, she follows up and making sure that they always have all of the proper follow-ups or exams necessary for additional care.

So, what we also want to discuss is our software has proprietary mechanisms to identify incidentals, I mean how are you enjoying using this new software?

Amanda Franklin (Haywood Medical Center):
oh, it’s amazing. That has really helped us to make sure we capture our incidental nodules that are failing and be you know ER reports and things like that, that sometimes fall through the cracks and primary not aware of it, so having that capability allows us to really make sure that we can get all these patients and make sure that they’re being followed appropriately.

Danielle Stackrow (Eon):
And I think that’s fantastic and since you’ve started using this software back in January have you noticed an increase in the patients?

Amanda Franklin (Haywood Medical Center):
We have yes. So, since we started using this previously I was relying upon our IT department to kind of pull reports for me twice monthly and since we started using this there’s been a definite increase which is you know very beneficial so that makes me feel more comfortable that all of our patients are truly being found so that we can manage them as they need to be.

Danielle Stackrow (Eon):
Right and not only I’m sure makes you feel more comfortable but also the patient’s that are being seen at your facility that they are getting the proper care that they need now.

Amanda Franklin (Haywood Medical Center):
The primary physicians and the ER physicians are more comfortable knowing that these patients are truly being felt because we have this system in place to help us.

Danielle Stackrow (Eon):
That’s what we like to hear.

Amanda Franklin (Haywood Medical Center):
It’s definitely been a huge asset to the facility here.

Danielle Stackrow (Eon):
That’s awesome to hear, we always like hearing that and you’re fantastic using this system and always up-to-date, following through with any exams or any follow-ups that these patients need, so they’re very unfortunate to have you using this software as well.

I really just want to say thank you so much for jumping on this call and talking to us about your experience with EonDirect.

Amanda Franklin (Haywood Medical Center):
Oh, no problem. I am very grateful for the system, it’s definitely helped our facility with keeping up with these patients and making sure they are being followed up.

Danielle Stackrow (Eon):
Thank you so much, Amanda.

Amanda Franklin (Haywood Medical Center):
Thank you.

EonCast: Chelsea Simpson and Tanisha Littlejohn from Wesley Medical Center share how EonDirect is optimizing their lung cancer screening program.

In our first ever EonCast, listen to Chelsea and Tanisha from Wesley Medical Center share their experience with EonDirect and how it has optimized their lung cancer screening program

 

Transcript

Danielle:
Hi everyone, I’m Daniel Stackrow and I’m the application specialist here at EonDirect. We’re starting a new video chat series twice a month checking in with our users to talk to them about how Eon Health’s EonDirect and see how it’s been impacting their incidental patient tracking and their lung screening at their hospitals.

Today with us we have Chelsea Simpson and Tanisha Littlejohn with Wesley Medical Center located in Wichita, Kansas. How’s your morning been going for you guys?

Chelsea & Tanisha:
Great. Good.

Danielle:
That’s awesome. So, first off, I really want to explain what step of the process you guys are in. Right now, EonDirect’s team is doing an audit on your historical backload of data while still registering your current patients to your EonDirect dashboard via our live interface streams with the end goal being a zero data entry for your Lung Cancer Screening program for both of you, which would be awesome. So, do you guys want to go ahead and kind of just explain what you guys were doing before you implemented EonDirect?

Chelsea:
Sure. So, we previously utilized a program that pulled data of patients that had incidental pulmonary nodules or lung cancer screenings. Both of those programs, the nodule and the screening program, we used an Excel spreadsheet to track all of that information. With the screening program we got up to about 500 patients and it started getting really heavy with the data entry aspect to the lung cancer screening registry. With the incidental nodule program, we had to track the follow-up, which included 6 and 12 month follow-up exams  and just constantly updated the Excel spreadsheet.

Danielle:
Right, do you mind if I go ahead and pull up those spreadsheets just so everyone can understand what you are referring to. I don’t know about you but Excel is not my friend so I don’t know how you guys made it work. So, can you see the spreadsheets?

Chelsea & Tanisha:
Yes.

Danielle:
So, this is the spreadsheet Chelsea was just talking about and I have no idea how you’re able to do this and then go ahead and be able to have all these individual fields uploaded and then tracked. If I scroll down at the bottom here is where you were able to have all of the incoming patients and the ones who needed to come in for a follow-up. Just going in and having to manually do that is a lot of time and effort, which a lot of nurses don’t have. So, do you think that EonDirect has been able to help change that?

Chelsea:
Well like you said excel can be very finicky at times and so the data entry aspect can get to be a lot of extra work and especially with creating the letters because Tanisha does the follow-up and she reminds the primary care physicians but she also has to do the patient and primary care physician letters explaining all of that. With EonDirect it creates the letters for us and so instead of doing the manual typing of the letters ourselves it can create the letter. And from a workflow aspect, we don’t have to deal with entering all of that data into the spreadsheet, as well as into the lung cancer screening registry because it is automatically pulled directly from EonDirect. That’s the best part.  The registry.

Danielle:
That’s great. So how has the transition from your Excel spreadsheet into Eon been? Do you mind walking through that and how that process has been for you guys?

Chelsea:
Sure, why don’t you talk about the data entry aspect. 

Tanisha:
For me it’s been a lot easier. We’re still working out the kinks of course but I mean that is with any new process, there is going to be hiccups. For me it’s a lot easier, I mean it’s less typing, less data entry (like you were saying Chelsea), less LCSR data submission. It goes a lot smoother and a lot quicker. Literally my favorite part is being able to click the whole list of patients and be able to submit with one click to the registry. That’s amazing and the best part for me. I don’t know about you.

Chelsea:
The registry. Before, it was a a lot of looking up in different programs. You would have to pull up multiple different data programs to be able to find the required data to enter into the website accurately, so it gets frustrating. So, to be able to pull that information from the report is a much simpler process.

Tanisha:
Yeah and I can’t wait until we’re all the way in! I mean it’s gonna be amazing all around.

Danielle:
That’s awesome thank you guys. And so you guys were able to sit down with Christine and Aki and go over the whole training process and introduction to EonDirect. How was just meeting them and the hands-on training. Do you mind talking about that?

Chelsea:
Yes, they were very engaged, very knowledgeable about their program it was obviously their baby. They really wanted to meet all of our needs as well and be able to speak to physicians, physician relations and administration on the reportable aspects and even how to track these incidental nodule and lung screening programs. Although each individual exam doesn’t seem like it’s making that much money for the hospital,  it can show the broader aspect of how important these programs are for patient care and follow through with pulmonary nodules and lung screenings. They also showed us each individual aspect of the software, how to use the program and how simple the program is to meet your own needs. The software is very easy to manage, it’s very simple, so we’ve been able to use it  going straight in. The software aspect is completely great.

Tanisha:
Yeah and on a personal level they make you feel so welcomed and they’re just really nice. And I don’t know about anyone else but I am a personal person. So walking in when they came, I was really nervous but when we sat down I was like oh okay. To know they’re very nice and welcoming, so we’re happy to be onboard.

Danielle:
And we love having you guys be a part Eon!  You guys are part of our family and are always talking to me over our in-app chat, it’s great.

Chelease:
And the chat feature is really nice.

Tanisha:
Awesome! I love it. Sorry Danielle (because I chat so much)

Danielle:
How has been the customer support through this whole process?

Chelsea:
Yeah, it’s been great. I mean we meet weekly to discuss the improvement and processes and everything that we can put into place to get this running smoothly in the long run and then the chat feature like we said it’s just right there. Everyone answers you right away and if there’s any questions or concerns that are needed to be answered quickly then it’s addressed, so it’s been great

Tanisha:
It’s really nice.

Danielle:
That’s awesome. So one last question – how do you see EonDirect really just affecting your overall workflow and process at Wesley?

Tanisha:
Oh it’s going to improve at least for me. The screening program in itself is such a huge thing. Our program is very large and so with the letters I know for me that’s going to help me so much, the automatic data entry that’s going to help a lot. I mean, just the screening alone is going to improve our workflow.

Chelsea:
The data management is going to save us so much time. I had another person in radiology that was submitting the required LCSR data for us so that’s another position that will be optimized, and both Tanisha and I have been using all of our time. I also do patient navigation so it’s going to allow me to pick up more patients as well as be able to really focus in on the patients that need quicker follow-up. I can get a lung team review for the nodule patients that have concerning nodules faster. It’s just going to be an easier workflow overall.   The traceability and analytics is great, it shows real time data and Excel spreadsheets don’t. I’m not good enough to do the money numbers in Excel, but to be able to show my hospital and my administration  all the work we put in. You know money talks and it’s important to know if these programs are really benefiting patients in the hospital. So, it’s great to have that ability to run those reports and show them the true positive aspects of these program.

Danielle:
Yeah that’s awesome. We are so excited to really finish out the implementation stage and really get going with you guys so you are utilizing the whole program. So thank you guys so much for jumping on this with me and kicking off our video chat series. Thank you guys so much.

Chelsea & Tanisha:
Thank you.

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.