Patient-facing EHR tool improves lung cancer screening identification

A simple nudge delivered through the electronic health record may help close one of lung cancer screening’s most stubborn gaps: identifying who is actually eligible. In a large randomized clinical trial, adding a patient-facing digital tool to existing clinician decision support significantly increased both the identification of screening-eligible adults and orders for low-dose CT scans, researchers reported December 26, 2025, in JAMA Oncology.

Lung cancer remains the leading cause of cancer-related death in the United States, yet screening uptake continues to lag. Although the US Preventive Services Task Force recommends annual low-dose CT screening for adults aged 50 to 80 years with a significant smoking history, only a small fraction of eligible individuals are screened each year. One major barrier is incomplete or outdated smoking history documentation in electronic health records, which makes it difficult for clinicians to quickly determine eligibility during already time-pressured primary care visits.

To address this challenge, Polina V. Kukhareva, Ph.D., M.P.H., a research assistant professor in the Department of Biomedical Informatics at the University of Utah, and colleagues tested a patient-centered, EHR-integrated intervention designed to complement existing clinician decision support. The MyLungHealth randomized clinical trial enrolled more than 31,000 adults aged 50 to 79 years receiving care at primary care clinics within University of Utah Health and New York University Langone Health between March 2024 and March 2025.

All participants had a documented smoking history and an active patient portal account. The trial included two parallel studies. One focused on patients whose screening eligibility was uncertain because of incomplete smoking data, while the other enrolled patients already documented as eligible for lung cancer screening. Clinics were randomized to provide either clinician-facing decision support alone or the same clinician tools plus MyLungHealth, a patient-facing portal tool that collected detailed smoking history and delivered personalized education about lung cancer screening in English and Spanish.

Among patients with uncertain eligibility, the addition of MyLungHealth more than doubled the likelihood that previously unclear eligibility would be clarified. Over 12 months, 4.7% of patients in the intervention arm were newly identified as screening eligible, compared with 2.3% in the control group. In patients already known to be eligible, low-dose CT ordering rates were also higher with the patient-facing tool, rising from 19.2% to 20.5%.

Although the absolute increases were modest, the authors emphasized that even small relative gains could have meaningful public health implications if implemented at scale. Lung cancer screening with low-dose CT has been shown to reduce lung cancer mortality by approximately 20%, and primary care is the main entry point for identifying eligible patients.

Notably, the intervention did not significantly increase CT completion rates among patients already eligible for screening, highlighting the persistent challenges of follow-through after an order is placed. The researchers suggested that future interventions may need to incorporate additional supports, such as automated reminders, navigation services or point-of-care scheduling, to further close remaining gaps.

Overall, the findings suggest that pairing patient engagement with clinician-facing systems can modestly but meaningfully improve lung cancer screening in primary care settings.

The study adds to growing evidence that patient-facing digital tools can complement clinician workflows and improve preventive care delivery. While MyLungHealth alone is unlikely to solve underuse of lung cancer screening, the findings suggest that engaging patients directly through the EHR can help primary care teams better identify who should be screened and start more potentially life-saving conversations.