HP239 – PCN DES early cancer tool
Introduction
This case study explores the deployment and impact of Primary Care IT’s (PCIT) HP239, supporting early cancer diagnosis by alerting users of patients with common symptoms known to lead to cancer. The protocol is built to flag repeated occurrences over 12 months and the protocol will prompt clinicians to “think cancer” for a timelier diagnosis.
Background/Challenge
Through discussions with a GP in Trafford, we were able to identify the need for additional support to be provided in ensuring early cancer diagnoses.
Dr Hannah Ward completed an audit looking at Cancer diagnoses which have been picked up outside of a 2 week wait referral across the PCN. In the audit she noted some patients who ultimately had a cancer diagnosis, presented with the same problem multiple times to primary care and concluded there potentially was some delay with further investigation’s being requested.
Dr Ward’s request was for PCIT to develop a pop-up box that will open after you code certain problems within EMIS. This pop up would say ‘this patient has presented with [diagnosis] 3 times in the last 12 months, have you considered Cancer?’. Dr Ward’s hope was that this would trigger a clinician to scroll back through the patient’s record and see if further investigations needed to be done.
PCIT was given the following criteria to review and consider when deciding what would prompt the alert:
- Shoulder pains
- Thoracic pains (and related codes)
- Thoracic back pains (and related codes)
- Abdominal pains (and related codes such as central pain, lower abdo pain, etc)
- Acid Reflux/GORD (and related codes)
- Loss of Appetite
- Weight loss – when coded as a problem (only unintentional or abnormal weight loss codes)
Solution
On saving the patient record, the protocol in place will consider the codes added and look at if there have been multiple instances of the same code in the last 12 months. If there has been codes added, the protocol will trigger differently depending on what the instances are and provide the user with further details prompting potential cancer diagnosis.
Outcome
With all the above considered, PCIT was able to develop and release an optional handy protocol (https://support.primarycareit.co.uk/portal/en-gb/kb/articles/hp239).
Following the launch of HP239, a short survey was given in the area which led to the following qualitative feedback:
- 100% of respondents had noticed the pop-up.
- 62.5% of respondents said that the pop-up prompted them to look back through the notes further.
- 50% of respondents said that the pop-up altered their plan in some way.
- 37.5% of respondents said that the pop-up prompted them to request further investigations.
- 25% of respondents said that the pop-up prompted them to carry out a two-week wait referral.
- 75% of respondents did not find the pop-up too distracting or that it triggered too much.
The general overview from the comments taken from both the survey and the PCN was that it is a good system.
Conclusion
This is an optional handy protocol. If you would like us to install this to your site please submit a ticket to request this. If your practice would like this Handy Protocol, it’s important to consider that users need to know that this alert may prompt them to review the case as the codes identified are commonly implicated in a later cancer diagnosis. This protocol relies on using the clinical system to record appropriate codes to reflect the symptoms the patient is experiencing.