Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Aleshire, Mollie

Committee Member

Winebrenner, Susan

Author's Keywords

Electronic health record reminders; colorectal cancer screening; primary care


Background: Colorectal cancer (CRC) is the third most common worldwide cause of cancer morbidity and mortality. CRC mortality is preventable through regular screening. Electronic health record (EHR) reminders for providers can increase providers’ CRC screening recommendations and lead to earlier CRC diagnosis. According to the National Cancer Institute’s Screening and Risk Factors Report for Kentucky by County 2008-2010, 62.7% of adults in a rural Kentucky county aged 50-75 had completed a home based FOBT in the past two years or have ever had a colorectal endoscopy.

Purpose: The purpose of this DNP project was to implement and evaluate an EHR CRC screening reminder for primary care providers (PCPs) at a rural Kentucky clinic.

Methods: All PCPs at a rural Kentucky clinic were provided a one-on-one training session to review current CRC screening guidelines, discuss how to manage EHR reminders, and train on how to consistently document CRC screening status. The IT team was provided a virtual training session to review how to extract EHR data to determine which patients need a screening reminder and how to code in the EHR so that there will be an automatic provider screening recommendation reminder based on documented screening status.

Intervention: EHR CRC screening reminders were inputted on all patients aged 45-75 who had been seen within the last three years and were not up to date with CRC screening based on documented screening status. Referrals were evaluated pre-intervention and compared to post-intervention data. CRC screening status documentation were evaluated post-intervention.

Results: There was a +22.8% change pre-post in provider CRC screening recommendations (33.7%; 56.5% respectively). Only 8.2% of CRC screening recommendations were documented in the new area of the chart.

Discussion: Implementing EHR CRC screening reminders provided a process that can increase CRC screening recommendations. In this study, 43.2% of patients were already up to date on CRC screening. 45.6% of patients refused CRC screening despite PCP recommendations being a key facilitator to screening updates.

Keywords: Electronic health record reminders, colorectal cancer screening, primary care

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