Improving ILD Screening in Patients With RA and SSc Using EHR-Embedded CDS and PRO Tools

Interstitial lung disease (ILD) is a common and serious complication of rheumatoid arthritis (RA) and systemic sclerosis (SSc). Despite guideline recommendations, ILD screening in routine care remains low, and many patients are not evaluated until their lung disease is advanced. This study evaluates a pragmatic, clinic-integrated strategy designed to increase timely ILD screening using tools embedded directly into the electronic health record (EHR). The project is conducted within community rheumatology practices that share a common EHR platform (NextGen). All participating sites transition from usual care to the intervention, but at different scheduled time points. This stepped-wedge design allows each site to contribute both control-phase and intervention-phase data. Screening is not researcher-initiated; instead, the intervention is designed to support and standardize existing clinical workflows. The intervention consists of two components implemented at the clinic level. First, patients complete a brief respiratory symptom survey on a tablet at check-in. The questionnaire captures dyspnea and cough severity and is designed to take under two minutes. The results become available to clinicians in real time. Second, EHR-embedded clinical decision support (CDS) prompts appear for clinicians when patients meet predefined criteria based on diagnosis, test history, and symptom scores. These prompts remind clinicians of guideline-recommended ILD screening and facilitate ordering of pulmonary function tests or high-resolution computed tomography when appropriate. Sites also receive training and a structured workflow guide to support implementation. Because the intervention is deployed within routine clinical care, patients are passively included when they present for appointments and meet study criteria in the EHR. No additional study visits, procedures, or medications are required. Data are collected from the EHR, CDS activity logs, and patient-reported surveys. The study observes ordering and completion of ILD screening tests, provider responses to alerts, symptom patterns, and documentation of new ILD diagnoses. Data are analyzed to compare screening activity before and after the clinic transitions to the intervention, adjusting for time effects and patient and site characteristics. The study aims to generate practical evidence on whether embedding guideline-aligned CDS and rapid symptom assessments into existing workflows can improve ILD screening for RA and SSc patients in real-world community practice. Findings may help inform broader implementation strategies for early detection of ILD and other pulmonary complications in rheumatology populations.