title: Augmented meaningful use criteria to identify patients eligible for lung cancer screening.
abstract: BACKGROUND
  Lung cancer screening (LCS) with low-dose-radiation (low-dose computed tomography [LDCT]) saves lives. Despite recent US Preventive Services Task Force (USPTF) draft endorsement of LCS, a minority of eligible patients get screened. Meaningful use is a set of standards for electronic health records (EHR) established by the Centers for Medicare and Medicaid Services and includes reporting of smoking status. We sought to improve rates of LCS among patients treated at our institution by identifying eligible patients using augmented smoking-related meaningful use criteria.
  
  
  METHODS
  We launched an LCS program at our institution, a National Comprehensive Cancer Network (NCCN) cancer center, in January 2013. We developed a "tobacco screen," administered by clinic staff to all adult outpatients every 6 months and entered into the EHR. This contained smoking-related meaningful use criteria as well as a pack-year calculation and quit date if applicable. Weekly electronic reports of patients who met eligibility criteria for LCS were generated, and EHR review excluded patients who had had chest computed tomography (CT) within 12 months or who were undergoing cancer treatment. We then contacted eligible patients to review eligibility for LCS and communicated with the primary treating physician regarding the plan for LCS.
  
  
  RESULTS
  During the first 3 months of the program, 4 patients were enrolled, 2 by physician referral and 2 by self-referral. We then began to use the tobacco screen reports and identified 418 patients potentially eligible for LCS. Over the next 7 months, we enrolled a total of 110 patients. Fifty-eight (53%) were identified from the tobacco screen, 32 (29%) were self-referred, and 20 (18%) were physician referrals. Three stage I lung cancers were detected and treated. The tobacco screen was easily implemented by clinic staff and took a median time of 2 minutes to enter for current and former smokers. Lack of response to attempts at telephone contact and objection to paying out-of-pocket costs were the most common reasons for failing to screen eligible patients.
  
  
  CONCLUSIONS
  Use of augmented meaningful use criteria containing detailed tobacco exposure history is feasible and allows for identification of patients eligible for LCS in a medical center. Barriers to LCS include lack of insurance coverage and lack of systematic referral of patients at high risk.
authors: Division of Thoracic Surgery, City of Hope Medical Center, Duarte, California; Tobacco Exposure Program, City of Hope Medical Center, Duarte, California. Electronic address: draz@coh.org.
authors: Dan J
authors: DJ
authors: Raz
authors: Tobacco Exposure Program, City of Hope Medical Center, Duarte, California.
authors: Rachel
authors: R
authors: Dunham
authors: Tobacco Exposure Program, City of Hope Medical Center, Duarte, California; Department of Pulmonary and Critical Care Medicine, City of Hope Medical Center, Duarte, California.
authors: Brian
authors: B
authors: Tiep
authors: Tobacco Exposure Program, City of Hope Medical Center, Duarte, California; Department of Pulmonary and Critical Care Medicine, City of Hope Medical Center, Duarte, California.
authors: Argelia
authors: A
authors: Sandoval
authors: Division of Thoracic Surgery, City of Hope Medical Center, Duarte, California.
authors: Frederic
authors: F
authors: Grannis
authors: Tobacco Exposure Program, City of Hope Medical Center, Duarte, California; Department of Radiology, City of Hope Medical Center, Duarte, California.
authors: Arnold
authors: A
authors: Rotter
authors: Division of Thoracic Surgery, City of Hope Medical Center, Duarte, California.
authors: Jae Y
authors: JY
authors: Kim
mesh_terms: D000368:Aged; D003663:Decision Trees; D055088:Early Detection of Cancer; D057286:Electronic Health Records; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D062527:Meaningful Use / Q000592:standards*; D008875:Middle Aged; D012907:Smoking; D014057:Tomography, X-Ray Computed