title: Racial differences in cancer screening with electronic health records and electronic preventive care reminders.
abstract: BACKGROUND
  Health information technology (HIT) can increase preventive care. There are hopes and fears about the impact of HIT on racial disparities in cancer screening.
  
  
  OBJECTIVE
  To determine whether electronic health records (EHRs) or electronic preventive care reminders (e-reminders) modify racial differences in cancer screening order rates.
  
  
  METHODS
  Using the 2006-2010 National Ambulatory and National Hospital Ambulatory Medical Care Surveys, we measured (1) visit-based differences in rates of age-appropriate breast, cervical and colon cancer screening orders between white and non-white subjects at primary care visits with and without EHRs, and, at visits with EHRs, with and without e-reminders, and (2) whether EHRs or e-reminders modified these differences.
  
  
  RESULTS
  Mammography (N=45,380); Pap smears (N=73,348); and sigmoidoscopy/colonoscopy (N=50,955) orders.
  
  
  RESULTS
  Among an estimated 2.4 billion US adult primary care visits, orders for screening for breast, cervical or colon cancer did not differ between clinics with and without EHRs or e-reminders. There was no difference in screening orders between non-white and white patients for breast (aOR=1.1; 95% CI 0.9 to 1.4) or cervical cancer (aOR=1.2; 95% CI 1.0 to 1.3). For colon cancer, non-white patients were more likely to receive screening orders than white patients overall (aOR=1.5; 95% CI 1.1 to 2.0), at visits with EHRs (aOR=1.8; 95% CI 1.1 to 2.8) and at visits with e-reminders (aOR=2.1; 95% CI 1.2 to 3.7). EHRs or e-reminders did not modify racial differences in cancer screening rates.
  
  
  CONCLUSIONS
  In this visit-based analysis, non-white patients had higher colon cancer screening order rates than white patients. Despite hopes and fears about HIT, EHRs and e-reminders did not ameliorate or exacerbate racial differences in cancer screening order rates.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Mishuris
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D006293:Health Promotion / Q000379:methods; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D044469:Racial Groups; D017010:Reminder Systems; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000208:ethnology
keywords: cancer screening; electronic health records; meaningful use; quality of care; racial disparities