Implementing USPSTF Recommendations for Breast Cancer Screening and Prevention by Integrating Clinical Decision Support Tools with the Electronic Health Record

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Project Summary/Abstract Clinical recommendations for breast cancer screening and prevention are contingent on breast cancer risk, yet methods to accurately determine risk for the 63 million women eligible for services are not widely used in practice. MammoScreen, a web-based application of a clinical decision support tool, was designed for women ages 40–74 years to identify their individual risks for breast cancer, engage patients in shared decision making, guide referrals, and consider screening decisions. Patients receive tailored information based on their risk profiles and preferences in accordance with USPSTF recommendations. The goal of this digitial healthcare research project is to improve access and quality of care for women, an AHRQ priority population. Although numerous breast cancer risk assessment tools are publically available, none exchange data with the patient’s electronic health record (EHR), missing important opportunities to fully integrate patient information into prevention decision-making at point of care. MammoScreen was developed and previously tested by the interdisciplinary team of investigators for the proposed project. In a pilot study, data from MammoScreen required manual entry into the EHR, which is not feasible across large health systems. The proposed project makes innovative use of the SMART (Substitutable Medical Applications, Resuable Technologies) on FHIR (Fast Healthcare Interoperability Resources) standard to exchange data to and from applications external to the EHR, such as MammoScreen, to fully integrate them into routine healthcare. The use of the SMART on FHIR standard will allow this approach to be scaled not only to a single health system, but to any EHR system that supports the SMART on FHIR standard. The objectives of this project are to demonstrate the ability of the EHR to securely exchange information with MammoScreen using interoperable, standards-based approaches; provide appropriate clinical and patient decision support for users; and evaluate its use among patients and clinicians using mixed methods based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). Accomplishing these goals would lay the groundwork for integration with other types of healthcare-related applications designed to extend decision support outside the clinical setting. Aim 1 (Years 1 & 2): Implement standards-based, safe, secure, interoperable integration of MammoScreen with the EHR. Aim 2 (Year 1 & 2 and again, Years 3 & 4) Evaluate MammoScreen acceptance by patients and clinicians to identify and remove potential barriers to use. Aim 3 (Years 3-5): Evaluate use of EHR-integrated MammoScreen by clinicians and patients across age groups (40–49 years; 50–74 years) and measure clinical outcomes.