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DTSTART;TZID=America/New_York:20250401T164500
DTEND;TZID=America/New_York:20250401T181500
UID:HFESHCS_2025 International Symposium on Human Factors and Ergonomics i
 n Health Care_sess148_POST295@linklings.com
SUMMARY:DH8 - Do EHRs Help or Hinder Coordination: Examining Facilitators 
 and Barriers of EHR to CRC Screening Process
DESCRIPTION:Poster Presentation\n\nMiad Alfaqih and Nicole Hammer (Univers
 ity of Florida); Trang Pham (University of Illinois at Chicago (UIC)); Sea
 n Pajak (Drexel University); Jessie Friedman (University of Florida); Ashl
 ey Hughes (Case Western Reserve University); Masahito Jimbo and Keith Nayl
 or (College of Medicine, University of Illinois at Chicago); Yamile Molina
  (University of Illinois at Chicago (UIC)); Nathan Stackhouse and Sean McC
 lellan (College of Medicine, University of Illinois at Chicago); and Megan
  Gregory (University of Florida)\n\nBackground: \nColorectal cancer (CRC) 
 is the second leading cause of cancer-related deaths in the United States 
 (American Cancer Society, n.d.). CRC screening  (CRCS) is a vital preventi
 ve measure that can reduce incidence and mortality through timely detectio
 n and intervention (DeGroff et al., 2018). Electronic health records (EHR)
  and patient portals, such as Epic’s MyChart, have the potential to stream
 line workflows and improve patient engagement in CRCS processes. However, 
 there are still challenges in fully leveraging these tools.\n\nThe purpose
  of this study is to explore the facilitators and barriers associated with
  EHR use in CRCS by examining the experiences of both healthcare providers
  and patients, with the goal of identifying areas for improvement in clini
 cal workflows and patient engagement.\n\nMethod \nWe conducted semi-struct
 ured interviews with both healthcare providers and patients. Our patient g
 roup consisted of individuals who had recently undergone CRCS at an academ
 ically affiliated network of FQHCs in the Midwest region of US.\n\nAfter o
 btaining consent from participants, we used the Zoom platform to hold inte
 rviews\nThese interviews were recorded and later transcribed verbatim for 
 analysis. All transcriptions were de-identified prior to analysis to ensur
 e participant privacy. ATLAS.ti Version 23.2.1 was used to analyze the int
 erviews (ATLAS.ti, 2023). We employed a mixed inductive-deductive coding a
 pproach, with two independent coders assigned to each transcript, ensuring
  all discrepancies were resolved through full consensus. The deductive cod
 ing was guided by Salas’s Heuristic Critical Considerations for Teamwork, 
 commonly referred to as the “C’s of Teamwork” (Salas et al., 2014). The qu
 alitative team then reviewed the codes to uncover emerging themes, focusin
 g on identifying facilitators and barriers related to the use of EHR in th
 e CRCS process.\n\n \nResults \nIn this study, 25 semi-structured intervie
 ws were conducted with 9 clinicians and 16 patients aged 45 to 75 to explo
 re current CRCS procedures, including the fecal immunochemical test (FIT) 
 and colonoscopy, as well as to examine the effectiveness of EHR systems in
  supporting CRCS based on the experiences of both clinicians and patients.
  This report underlines the significant role of the EHR in supporting the 
 screening process and points out specific challenges and areas for improve
 ment. By analyzing participants' responses, we identified key themes regar
 ding the use of EHR and patient portals in CRCS. The findings below outlin
 e the current facilitators and barriers to effectively using these systems
  in the screening process.\n\nCurrent Facilitators \n•	Epic Chat: Clinicia
 ns found the Epic Chat feature helpful for real-time communication with me
 dical assistants (MAs) and patient navigators, even when team members were
  not physically present. When discussing the CRCS process, one provider sh
 ared, “‪I would say with Epic, and being able to have the chat feature, so
  that even if the navigator isn't here, I can send a message, and the navi
 gator can always respond.”. ‬‬‬‬‬‬‬\n\n•	Alerts: Alerts in the health main
 tenance status module of some EHR systems serve as a key facilitator by re
 minding clinicians when patients are due for screenings. At the institutio
 n we studied, alerts in the EHR prompted providers to review or order nece
 ssary tests, such as a FIT test or colonoscopy, ensuring screenings were a
 ddressed during the visit (Patel et al., 2016). One clinician noted the va
 lue of these reminders: “Epic is nice, too, because I have a feature in my
  note that lets me know what health maintenance the patient is due for."\n
 \n•	Pending Orders in Epic: This feature in Epic contributes to the effici
 ency of the CRCS process by allowing clinical staff, such as medical assis
 tants or navigators, to preemptively enter orders for tests like the FIT t
 est or colonoscopy. These orders remain pending until reviewed and signed 
 by the provider, ensuring that the screening process can proceed without u
 nnecessary delays. As one clinician described, "If it seems that someone i
 s potentially eligible for stool-based testing, they will let that patient
  know that they will pend orders on the visit, so that when providers show
  up and see the patient within the EMR, there's already a pended stool tes
 t.”. \n\n•	MyChart: Many patients find the MyChart patient portal to be a 
 useful tool for accessing results and communicating with their healthcare 
 providers regarding CRCS. Patients often receive important messages throug
 h the portal, facilitating efficient communication. One patient said, “The
 y always tell me that I can have, you know, any results on MyChart,” demon
 strating how they used the platform to check test results. Another patient
  mentioned how they used MyChart messages to communicate with their provid
 er: “I sent her a message and she called me back to get my appointment on 
 Monday”. \n\nBarriers/Issues\n•	Digital health literacy: Digital health li
 teracy presents a barrier to effective CRCS, as it impacts how patients ac
 cess their results and communicate with providers using tools like MyChart
 . Patients with limited digital skills may struggle to retrieve important 
 information or engage in timely follow-up. One patient shared, “when I wen
 t to my next appointment, I asked the doctor about the results,” instead o
 f using MyChart to access or communicate about their screening results. Th
 is reliance on in-person visits reflects the difficulties some patients fa
 ce in utilizing the platform, indicating there is not a “one size fits all
 ” approach to patient-facing digital health for CRCS. \n\n•	Lack of Custom
 ization: Clinicians expressed concerns that while EHR alerts and reminders
  are helpful, they are not always customized to account for individual fac
 tors, such as a patient’s family history or specific risk factors. One cli
 nician pointed out, "The patient history, including family history, is loc
 ated within the record, but why is this not a flag or data used in a clini
 cal decision support tool? Seems like a missed opportunity to use the reco
 rd to promote more risk-concordant screening." Another clinician stated, "
 That might be variable by physicians, and…how their notes and things are s
 et up,”  suggesting that system customization is inconsistent across provi
 ders. \n\n•	Interoperability: Another challenge in the CRCS process is the
  lack of interoperability between health systems’ EHRs. One clinician shar
 ed that he had to cancel many FIT tests pended by navigators because patie
 nts had already completed screenings elsewhere, but the information was no
 t accessible due to different EHR systems. The clinician explained, “So, i
 n our community a lot of the patients have had a colonoscopy, and she just
  wasn't aware of it or couldn't access it in the chart, because it's in a 
 different system that doesn't use EPIC.” \n\n•	Use of After-Visit Summarie
 s: Some clinicians reported that MAs frequently don’t read after-visit sum
 maries (AVS) which often contain instructions to provide patients with FIT
  tests at check-out, leading to missed screenings. When asked what could b
 e improved, one provider said, "I would really like it if the MAs would re
 ad what's in the AVS and actually give people the FIT test." Another clini
 cian added, "some of the people are still thinking, ‘if it wasn't told to 
 me verbally, then it's not a thing’, even though it's right there in the c
 hart.” \n\nDiscussion \nOur study offers valuable insights for healthcare 
 providers, clinical informaticians, and researchers by illustrating both t
 he potential and limitations of EHR systems in supporting CRCS. While feat
 ures like real-time communication and automated reminders can streamline w
 orkflows and improve screening efficiency, challenges such as limited syst
 em customization and low digital health literacy hinder the full utilizati
 on of these tools. Addressing these barriers through enhanced system desig
 n and targeted patient education could lead to better CRCS outcomes. Impro
 ved integration and personalization of alerts may further support efforts 
 to increase screening rates and enhance patient care.
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