EHR Nudge Boosts Gynecologic Oncology Referrals, Speeds Diagnosis of Early Ovarian Cancer

A pilot study from the University of Pennsylvania found that an electronic health record (EHR) nudge to prompt gynecologic oncology referral for suspected ovarian cancer increased referral rates from 55% to 75% and led to earlier diagnoses, including four stage I cancers. The intervention also cut referral time in half, from 20 to 10 days. The study, presented by Anna Jo Smith, MD, MPH, addressed a critical gap in ovarian cancer care, where nearly one-third of patients are never referred to a gynecologic oncologist despite evidence that specialist care improves survival.

Using natural language processing to review radiology reports, the study identified patients with Ovarian-Adnexal Reporting and Data System (O-RADS) scores of 4 or 5, indicating a 10% to more than 50% risk of ovarian cancer. For patients not previously seen in gynecologic oncology, a nudge with a default referral order was sent to the clinician who ordered the imaging within 48 hours of the abnormal result. The pilot was conducted from January to March 2024 and included 38 patients identified as having suspicious imaging findings. After excluding patients with pre-existing referrals, inaccessible providers, or delayed O-RADS scoring, 20 clinician nudges were issued.

Following the nudge, 75% (15 out of 20) of patients were referred to gynecologic oncology, compared with a historical referral rate of 55% among similar patients identified between 2020 and 2023. Among the clinicians who received the nudge, 30% reported that the alert changed their decision, indicating they would not have referred the patient without the prompt. The mean time from imaging to referral decreased from 20 days in the historical cohort to 10 days in the intervention group. Of those referred, 75% had a gynecologic oncology visit within 90 days of abnormal imaging, compared with 56% historically, with a mean time to specialist visit of 29 days. Eleven patients went on to undergo surgery with gynecologic oncology, and cancer was identified in four patients, all at stage I. Three were diagnosed with stage IA ovarian cancer and one with stage I appendiceal cancer.

“A clinician nudge standardizes gynecologic oncology referral and appears to improve early detection of ovarian cancer,” the study author concluded. “A randomized controlled trial of the clinician nudge is planned.”

Reference:
Smith AJ. Clinician nudge to gynecologic oncology referral at suspected ovarian cancer diagnosis: A pilot study. Paper presented at: Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Accessed March 11, 2025. https://www.sgo.org/events/annual-meeting/