Automated Clinical Decision Support and Electronic Health Record Tracking of Patients With Adenomas Found on Colonoscopy

Importance Surveillance colonoscopy following adenoma detection is essential for colorectal cancer prevention, yet systematic tracking within electronic health record (EHR) systems remains challenging, as they rely on manual data entry. Objective To determine if implementation of an automatic tool in the EHR is associated with improved health care maintenance table updates for patients needing repeat colonoscopy for cancer screening after adenoma detection. Design, Setting, and Participants This cohort study at a single tertiary care center within a large health care organization with EHR functionality included patients undergoing colonoscopy between November 2017 and December 2024. Eligible participants were adults aged 50 to 75 years undergoing colonoscopy for screening, surveillance, or diagnostic indications. Exclusion criteria included patients with inflammatory bowel disease, known colorectal cancer, or hereditary cancer syndromes. Data were analyzed between January and May 2025. Exposure A decision support tool was implemented that allowed gastroenterologists completing colonoscopies for patients with adenoma to choose follow-up intervals that would automatically populate the health maintenance tab. Main Outcomes and Measures Rate of updates of the health maintenance table and percentage completion from gastroenterology vs primary care. Results A total of 35 802 patients met criteria (20 049 female [56.0%]; median [range] age: preintervention, 61 years [50-75 years]; postintervention, 62 years [50-75 years]); adenomas were detected in 8004 of 18 027 patients (44.4%) in the preintervention period and 8396 of 17 775 patients (47.2%) in the postintervention period. Health maintenance updates for patients with adenomas requiring closer surveillance increased significantly, from 83.4% (6672 of 8004 patients) to 94.2% (7913 of 8396 patients) following the intervention ( P < .001). Gastroenterology team completion of health maintenance updates increased postintervention from 67.6% (5413 of 8004 patients) to 91.9% (7717 of 8396 patients). Conversely, primary care team updates decreased significantly from 9.3% (746 of 8004 patients) to 1.4% (118 of 8396 patients) following the intervention ( P < .001 for both). Population health automatic updates occurred in a small number of patients in both periods. Conclusions and Relevance Implementation of automatic updates to the health maintenance section of the EHR was associated with significantly increased the reliability of postadenoma surveillance documentation; after the intervention, gastroenterology reporting increased while the primary care burden was reduced. These findings suggest that clinical decision support implementation is critical for accurate adenoma surveillance intervals.