Jennifer Elston Lafata, Eshelman School of Pharmacy
Colon cancer screening remains underutilized in the United States. Even among insured patients who receive a physician recommendation, only about half go on to be screened within the following year. In partnership with the Henry Ford Health System (HFHS), we are developing and testing a decision-support program to facilitate adherence to physician-recommended screening. The program, called e-assist: colon health, is embedded within the electronic health record (EHR), tailored to clinic workflows, and includes personalized, patient-targeted educational messaging that addresses psychological and logistical barriers to screening as well as clinician-targeted prompts (“best practice alerts”). Continual user input characterizes development from conceptualization to implementation. Information compiled from patient surveys and office visit audio-recordings enabled an in-depth understanding of information and other gaps in typical office visit conversations. Partnerships with HFHS clinician leaders and quality staff, including a programmer with extensive EHR knowledge, shaped program priorities and key design concepts. Engagement with standing HFHS ambulatory and gastroenterology quality teams ensured integration with existing clinic workflows and appropriateness of all patient-targeted material relative to local practices. Patient focus groups informed program name, logo, and content; one-on-one interviews with HFHS patient advisors refined program content as well as program look and feel; and beta testing via in-depth interviews with program-eligible patients ensured usability, meeting user content expectations, and material comprehension. This process of comprehensive and continual user input is continuing throughout program testing to ensure the resulting intervention, if effective, is adaptable for local context, and purposely designed for sustainable and scalable.