A cloud-based digital health navigation program for colorectal cancer screening

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Over 30% of age-eligible Americans fail to receive recommended screening for colorectal cancer (CRC), the second leading cause of cancer death in the United States. Multilevel barriers explain why so many Americans fail to receive routine CRC screening. Patients report a lack of knowledge about the need for screening or their screening options, and many view screening as messy, uncomfortable, or embarrassing. Busy clinicians report a lack of time to deliver preventive care, and many clinicians only discuss colonoscopy. Lastly, healthcare systems lack strategies to reach out to patients independent of a scheduled medical visit. Disruptions caused by COVID19 also have led to a decrease in the use of preventive services. To address these multilevel barriers, our team has developed and tested a tablet-based digital health navigator for colorectal cancer screening called mPATH™ (mobile Patient Technology for Health). mPATH™ determines if patients are due for CRC screening, educates them about their options, and lets them request a screening test directly via the program. In a randomized controlled trial conducted in primary care practices, mPATH™ doubled the proportion of patients who completed CRC screening and had excellent usability ratings. However, we have learned that our tablet-based model of mPATH™ is difficult to scale as it requires on-site training and changes to workflows. The goal of this Fast Track STTR proposal is to develop and test a cloud-based version of mPATH™ that patients can use at home independent of a scheduled medical visit. Patients will access mPATH™ on their own devices using a hyperlink sent via text message or patient portal. The cloud version of mPATH™ will have the proven effective content of the tablet version, including the ability to request a screening test directly via the program. mPATH™ will then share this information with the patient’s healthcare organization so screening can be arranged. This cloud-based version will be highly scalable, have broad reach, and be easy to support, making it a commercially viable product. To accomplish this goal, the work of this proposal will: (1) create a culturally appropriate and engaging cloud-based version of mPATH™ by leveraging input from community members, an expert Scientific Advisory Committee, and feedback from users; (2) determine the feasibility of the cloud-based mPATH™-CRC web app in a highly pragmatic pilot trial conducted in a large health system; (3) test the reach and effectiveness of the mPATH™ web app in two different healthcare settings: a large health system, and an Accountable Care Organization that includes rural Federally Qualified Health Centers; and (4) determine the value generated by mPATH™ in each healthcare setting. This Fast Track STTR will provide information that is critical to mPATH™’s future commercialization by demonstrating its reach into diverse populations, its effectiveness in increasing screening, and the value it generates to potential future customers. If successful, mPATH™ will fill a critical need for a commercially available, easily scalable solution for colorectal cancer screening and potentially other preventive services.