Increasing Screening for Cancer Using EHR-Nudges Replication

In this study, personalized nudges to clinicians and patients will be evaluated to help increase breast cancer screening rates in accordance with USPSTF guidelines among women with a primary care visit. In partnership with Penn Medicine (Penn) and Case Western Reserve University-University Hospitals (UH), two complementary, concurrent 6-month, cluster randomized, pragmatic trials were conducted from December 2023 to October 2024. This trial will now replicate those interventions at Lancaster General Health (LGH), incorporating learnings from the primary trials while also adapting to align with existing health system protocols and policies. The patient nudge interventions include pre- and post-visit text message reminders to encourage the patient to schedule their mammogram, and the clinician nudge intervention includes a Smart Data Element message in the electronic health record (EHR) reminding the care team that the patient is overdue and that patients are more likely to complete their screening if recommended and ordered by their clinician.

Inclusion Criteria: All patients must meet the following criteria to be eligible: 1. Women between 40 and 74 years of age 2. A scheduled new or return (non-urgent/sick) primary care visit at one of the study practices at Lancaster General Health 3. Are overdue and eligible for a mammogram per Epic Health Maintenance 4. Does not have a future scheduled mammogram appointment Patients meeting at least one of the following criteria will be considered high risk for screening non-completion: 1. Medicare Insurance 2. Medicaid Insurance 3. No EHR patient portal account 4. Zero log-ins to EHR patient portal in the previous year Exclusion Criteria: Patients will be excluded from the study if they: 1. Have a history of bilateral mastectomy, breast cancer, or metastatic cancer 2. Have a mammogram exclusion modifier in Health Maintenance 3. Have no phone number (home or mobile) listed in their chart