This is a quality improvement initiative that aims to find better ways to identify interstitial lung disease (ILD) early in people with rheumatoid arthritis (RA) or systemic sclerosis (SSc). ILD is a serious lung problem that can develop in these conditions but is often missed. The project will test whether tools built into the electronic health record (EHR), including symptom surveys that patients complete on a tablet and alerts that help doctors decide when lung testing is needed, can increase screening rates.
About 16 rheumatology clinics that use the same EHR system will take part. All clinics will eventually use the new tools, but they will start at different times. This allows researchers to compare usual care to the new approach within each clinic.
Adults with RA or SSc who have not previously been diagnosed with ILD and who have not had recent lung testing will be included automatically through their routine clinic visits. The study expects to include about 800 patients in total.
The main question is whether more eligible patients receive recommended ILD screening, which includes either a pulmonary function test or a high-resolution CT scan, within seven days of their clinic visit. The study will also look at how often lung tests are ordered and completed, how often patients report symptoms such as shortness of breath or cough, and whether the alerts lead to real-time clinical decisions.
This project lasts two years and uses information already collected during routine clinical care. No additional procedures or medications are required.
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Sequential
EHR-Embedded CDS and PRO Tools Intervention
Other interventionThis intervention integrates two components directly into routine rheumatology clinic workflows using the shared NextGen electronic health record (EHR). First, patients complete a brief tablet-based respiratory symptom questionnaire at check-in, capturing dyspnea and cough severity in under two minutes. Responses are transmitted instantly into the EHR. Second, the system activates ILD-focused clinical decision support (CDS) prompts for clinicians based on diagnosis, prior testing history, and symptom scores. These prompts recommend guideline-aligned ILD screening and provide structured options for ordering pulmonary function tests or high-resolution chest CT. The CDS also records provider responses and reasons for deferring screening. The intervention is deployed at the site level and is intended to standardize ILD screening behavior, enhance recognition of respiratory symptoms, and support timely clinical action in RA and SSc patients.
Receipt of ILD Screening
Proportion of eligible patients who receive an ILD screening test (high-resolution CT \[HRCT\] or pulmonary function test \[PFT\]) within 7 days of a clinic visit.
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Foundation for Advancing Science Technology Education and Research
Lead sponsor
Boehringer Ingelheim
Collaborator
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