Screening tests are only one part of effective cancer screening programs. Real-world impact also depends on how screening is delivered and supported.
Patients need clear information, practical access, and support through recommended follow-up. Care teams need timely data and workflows to identify patients due for screening, engage patients, and coordinate next steps.
Even for a single patient, information may be incomplete or scattered across the health record, and screening may span care teams. Managing that complexity can require substantial manual effort. At the population level, manual processes alone cannot provide the consistent coordination and visibility required by care teams and health system leaders.
Studies on cancer screening participation¹˒² highlight patient challenges including transportation, additional appointments, and time away from work or caregiving responsibilities. Fragmented pathways and limited coordination can create further friction. Limited awareness, health literacy, language, fear, and stigma can also impede participation. Patients facing more challenges are less likely to complete recommended screening. Because these challenges are not experienced evenly, participation gaps can compound existing health inequities.
Integrating additional screening options into routine care
Blood-based testing can address some practical obstacles by fitting more readily into routine care. As the first article in this series explored, Personalized Cancer Detection (PCD) is Freenome’s approach to blood-based cancer screening. PCD will soon be delivered through the SimpleScreenTM portfolio, which will initially include indication-specific blood-based tests for lung and colorectal cancer screening, with additional tests in development.
PCD is designed to complement, not replace, established screening methods. It gives care teams another way to reach patients not completing those methods by offering tests relevant to their screening needs and circumstances. When multiple tests are appropriate, they can be completed using one blood draw.
An accessible option alone is often not enough. It must fit within a coordinated process from patient identification through follow-up.
Evidence suggests digital interventions can support several points in this process. In one randomized pilot, electronic outreach and a smoking-history questionnaire helped identify patients eligible for lung cancer screening and support participation.³ In a cluster-randomized trial of nearly 12,000 patients with overdue follow-up after abnormal screening results, EHR reminders combined with patient outreach improved timely completion compared with EHR reminders alone or usual care.⁴
Connecting patients, care teams, and screening workflows
Freenome Digital Health will combine EHR-native capabilities with Freenome consultation and resources to help health systems put PCD into practice across the screening journey.
EHR data can help surface patients who may be eligible or overdue for screening. Patient engagement can include surveys to collect missing eligibility data and providing accessible education so patients can understand why screening matters, consider their options, and prepare for informed conversations with their care team.
Once a screening opportunity is identified, care teams can use information about patient eligibility to guide and streamline screening conversations. Support can continue beyond the initial test order: reminders can encourage patients to complete the blood draw, while post-test patient education and support can help patients and care teams complete the appropriate downstream evaluation after a positive result.
These capabilities operate natively within a health system’s EHR rather than through a separate vendor portal. A national study found that ambulatory physicians averaged 5.8 hours of EHR work for every eight hours of scheduled patient care.⁵ Given that workload, the goal is not simply to add or use more technology within the EHR. The value comes from combining each health system’s EHR tools with Freenome consultation and resources to improve how screening is integrated into existing care team workflows. Freenome will collaborate with founding health system partners to prioritize a tailored set of capabilities and support their implementation based on each system’s goals, readiness, and capacity.
Building for today and what comes next
Alongside support for individual patient journeys, reporting can provide program-level visibility into screening participation, follow-up completion, trends over time, and variation across clinics or patient populations. That visibility can help leaders understand overall performance, identify persistent gaps, and focus improvement efforts where needed most.
As the SimpleScreen portfolio expands, health systems can extend a connected approach across more cancer risks without constructing a separate program around each indication. Together, PCD and Freenome Digital Health can support patients in accessing, completing, and remaining current with appropriate screening; help care teams act on timely information within existing workflows; and help health-system leaders use program-level insight to guide improvement over time.
Health systems interested in shaping a more personalized and connected approach to cancer screening can learn more about Freenome Digital Health and the Founding Partner Program.
References
- Cavers D, Nelson M, Rostron J, et al. Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature. Respir Res. 2022;23:374. doi:10.1186/s12931-022-02255-8.
- Zhu X, Weiser E, Jacobson DJ, et al. Provider-perceived barriers to patient adherence to colorectal cancer screening. Prev Med Rep. 2022;25:101681. doi:10.1016/j.pmedr.2021.101681.
- Begnaud AL, Joseph AM, Lindgren BR. Randomized electronic promotion of lung cancer screening: a pilot. JCO Clin Cancer Inform. 2017;1:1-6. doi:10.1200/CCI.17.00033.
- Atlas SJ, Tosteson ANA, Wright A, et al. A multilevel primary care intervention to improve follow-up of overdue abnormal cancer screening test results: a cluster randomized clinical trial. JAMA. 2023;330(14):1348-1358. doi:10.1001/jama.2023.18755
- Holmgren AJ, Sinsky CA, Rotenstein L, Apathy NC. National comparison of ambulatory physician electronic health record use across specialties. J Gen Intern Med. 2024;39:2868-2870. doi:10.1007/s11606-024-08930-4.
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