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Decision Precision+

Problem:

Lung cancer is the leading cause of cancer deaths, and lung cancer screening through low-dose CT scans could save more lives than breast cancer screening. However, less than 10% of eligible Americans are screened each year. An important reason for this lack of appropriate screening is that lung cancer screening requires the review of patient-specific benefit and risk information using a decision aid, but such shared decision making is cumbersome without effective decision support tools integrated with the EHR.

Solution:

Decision Precision+ is an EHR-integrated decision aid that provides individualized benefit and risk information using state-of-the art risk models from the National Cancer Institute. It is seamlessly integrated with the EHR and enables high-quality shared decision making in busy clinical settings. After deployment at University of Utah Health, the rate of lung cancer screening increased 4-fold (CHEST 2023).

Summary

Decision Precision+ is a SMART on FHIR application that pulls in a wide range of relevant data from the EHR and provides patient-specific guidance on benefits and risks.  The tool uses the U.S. Preventive Services Task Force guidelines to determine which patients should be considered for lung cancer screening, then uses lung cancer risk and life expectancy models from the National Cancer Institute (https://dceg.cancer.gov/tools/risk-assessment/lcrisks) to provide patient-specific benefit and risk information.

A stand-alone version of the tool, known as Decision Precision, is available to all at https://screenlc.com/. The EHR-integrated version of the tool is also available for free.

The initial development of the standalone Decision Precision tool was funded by the Veterans Administration, with the work led by Dr. Tanner Caverly and Dr. Angie Fagerlin. The subsequent conversion of the tool into the EHR-integrated Decision Precision+ tool was funded by the Agency for Healthcare Research and Quality (AHRQ) (R18 HS026198), with the work led by Dr. Kensaku Kawamoto. A subsequent AHRQ grant is supporting the development of a complementary patient engagement tool known as MyLungHealth, as well as the provision of free dissemination and implementation support to any health systems interested in incorporating Decision Precision+ into their lung cancer screening programs (R18 HS028791).

Technical Details

Screenshot

A screenshot of Decision Precision+ is provided below:

FHIR Resources used

Decision Precision+ uses the following FHIR resources:

  • Patient
  • Conditions
  • Family Member History
  • Observations

Utah Biomedical Informatics Team

Kensaku (Ken) Kawamoto, MD, PhD, MHS, FACMI, FAMIA – Project PI, Associate CMIO, Professor of Biomedical Informatics and Vice Chair for Clinical Informatics, Director of ReImagine EHR, Co-Senior Director of Digital Health Initiative
Claude Nanjo, MPH, MAAS – Senior Clinical Informaticist
Douglas Martin, MD – Adjunct Professor and Senior Clinical Informaticist
Christian Balbin - Pre-doctoral fellow
Guilherme Del Fiol, MD, PhD, FACMI, Professor of Biomedical Informatics and Vice Chair for Research, Research Director of ReImagine EHR, Co-Senior Director of Digital Health Initiative
Isaac Warner – Research Assistant
Jorie Butler, PhD - Associate Professor of Geriatrics and Biomedical Informatics
Leticia Stevens - Clinical Informaticist
Phillip Warner, MS – Senior Software Design Engineer
Polina Kukhareva, PhD, MPH – Assistant Professor of Biomedical Informatics, Director of Quantitative Evaluations for ReImagine EHR
Salvador Rodriguez, PhD – Software Design Engineer

Vicky Tiase, PhD, RN - Assistant Professor of Biomedical Informatics and Director of Strategic Development for Digital Health Initiative

Other University of Utah Collaborators

Angie Fagerlin, PhD – Professor and Chair, Dept. of Population Health Sciences
Chakravarthy Reddy, MBBS – Associate Professor of Pulmonology
Michael Flynn, MD – Community Clinics Associate Medical Director for Research and Clinical Innovation
Rachel Hess, MD, MS – Professor of Internal Medicine and Population Health Sciences and Associate Vice President for Research, University of Utah Health
Yue Zhang, PhD – Associate Professor of Biostatistics

University of Michigan

Tanner Caverly, MD, MPH – Assistant Professor of Learning Health Sciences and Internal Medicine

Intermountain Healthcare

Pallavi Ranade-Kharkar, MS, PhD, FAMIA – Director of Research Informatics and Precision Health Systems

NYU Langone Health

Devin Mann, MD, MS – Senior Director of Informatics and Innovation

References

Project highlight in AHRQ Research Stories

Software

Decision Precision: stand-alone Web tool (https://screenlc.com/)

Decision Precision+: EHR-integrated SMART on FHIR app (freely available for integration with multiple EHR systems — contact ReImagineEHR@utah.edu for details)