Lansing practice uses electronic medical record alerts for breast cancer screening

Dr. Barbara Fretwell uses electronic medical record alerts

It can be a challenge for busy practices to keep track of annual screenings for their patients. But Barbara Fretwell, M.D., has found that using electronic medical records helps her practice, Capital Internal Medicine Associates, ensure that all eligible patients get breast cancer screening.

“There’s a section in the electronic medical record, called Alerts, where medical assistants can indicate when the last mammogram was done and when the patient is due,” explains Dr. Fretwell. “We keep progress notes at the annual exam, but we also check the alerts at every visit.”

The office has increased emphasis on tracking screenings since it became a certified patient‑centered medical home. “There’s definitely an emphasis on making sure we’re doing the screening and documenting when it gets done.”

“The system isn’t foolproof,” admits Dr. Fretwell. “It only works when the assistants take the time to check the alerts in the record. And it’s up to the doctors to order the tests.”

Patient education is also important to making sure women get an annual mammogram.

“I talk to patients about the importance of screening so they buy into it,” says Dr. Fretwell. “I tell them what the American Cancer Society guidelines are. Also, while I’m doing an exam, I tell them to let us know if they feel a lump because it doesn’t always show on a mammogram.”

The office also provides shower hangtags to remind and educate patients about breast self‑exams.

Communication with radiologists also helps the office track that patients had their mammograms done. Whether a patient chooses the breast center affiliated with the practice or another imaging center, the results go directly into the electronic medical records. “The technician at our breast center is friendly with patients and will call or email me if they see abnormal results so I can follow‑up with the patient,” says Dr. Fretwell.

There are a few challenges to screening. “Some women flat out refuse to go for a mammogram,” says Dr. Fretwell. “I have some patients with breast implants and they don’t want to get a mammogram because they’ve had trouble with their implants. In those cases, I still emphasize what the American Cancer Society guidelines recommend.”

“I’d like to devise a better system for identifying high‑risk women,” continues Dr. Fretwell. “I still recommend an annual mammogram for women over 55 with higher risks, even though the guidelines have changed. I recently had a woman in her 70s diagnosed with breast cancer. She has a mother and sister with breast cancer and, thankfully, has been faithfully screening for years.”