Macmillan, Cancer Research UK and BMJ pilot

Winner of the 2014 HSJ Award for 'Value and Improvement in Information Technology'.

“We have just detected our first patient with lung cancer with this tool... This patient would not have been referred without this tool being in place.”

Identifying patients who should be referred for suspected cancer is challenging. GPs are faced on a daily basis with patients displaying a variety of symptoms, which may or may not be cancer.

There exists a strong evidence base for primary care cohort-based risk algorithms to quantify risk of cancer. In response to this evidence base, BMJ worked with Macmillan Cancer Support to pilot a software based clinician decision support (eCDS) tool in over 1,000 GP practices in UK.

The eCDS toolset is designed to assess the risk of a patient having an existing, but as yet undiagnosed cancer, by calculating a risk based on factors such as symptoms, medical history and demographic profile. The tool was developed by BMJ with insight from Macmillan’s primary care community. It is IT-based with a simple user interface which can display scores based on two risk calculators for cancer: the Risk Assessment Tool (RAT), developed by Professor Willie Hamilton and QCancer developed by Professor Julia Hippisley-Cox.

The tool works in three ways:

1. Reactive prompts. Working automatically in the background, the tool will calculate a risk of having cancer for every patient seen in consultation. If the risk is above a certain level, a prompt will appear on screen, at the point of care, letting the GP know that they might like to consider whether the patient might warrant a referral or investigation for a suspected cancer.

2. Symptom checker. Used in consultation where READ codes are not already known, a symptom checker can be called up, which allows the GP to enter relevant symptoms, calculate a risk, and then re-enter observed symptoms into the patient’s record as a READ-coded entry.

3. Audit function. Out of consultation, an audit function can be used which will show calculated risk levels of all registered patients on a practice’s list. This can be sorted to show those calculated to have the highest risk, and then used to consider whether any further action should be taken for these patients.The programme has been deemed successful by BMJ. Over 65% of practices that currently subscribe to BMJ products have installed and are using the eCDS tool.   

The success of the eCDS tool pilot scheme has lead to the investment for significant improvements to create better usability and support faster diagnosis: both eRAT and QCancer calculators will trigger as pop‐up notification from the patient record, where the patient meets a defined threshold of a 2% risk of a cancer.  Notifications for each ‘triggered cancer’ will provide the clinician with the risk of the cancer and the contributing symptoms.   

Cancer Research evaluated the pilot at the end of 2014 and found the risk perceived by the GP of a patient having cancer and that calculated by the eCDS tool was different in 46% of cases. We have also found nearly 20% of patients referred would not have been if the tool had not been used. Over 1,000 customers are now using the eCDS Tool and it will soon be available free of charge to all GP practices through the GPSOC Framework. It is  available free to subscribers of certain BMJ products and all practices taking part in the nationwide CKD audit.

The walkthrough guide for GPs can be found here