Highlight
This study demonstrates that redesigned electronic health record (EHR) patient portal reminders, using brief messages coupled with scheduling links, significantly improved adherence to mammography screening. However, similar redesign efforts did not enhance retinal or HbA1c screening rates. Personalized mammography reminders did not outperform non-personalized messages in scheduling adherence.
Background
Preventive care screenings, such as mammography for breast cancer and retinal or HbA1c testing for diabetes management, are essential for reducing morbidity and mortality. Despite established guidelines, adherence to these screening recommendations remains suboptimal, posing a public health challenge. Electronic patient portals in healthcare systems offer an opportunity to improve preventive care uptake through patient reminders. Yet, optimal design features of such reminders to maximize patient responsiveness remain unclear.
Study Design
This pragmatic quality improvement study was conducted within outpatient clinics affiliated with NYU Langone Health (NYULH). The target population included patients due for retinal screening, HbA1c testing, or mammography. Using a behaviorally informed framework, the investigators iteratively redesigned electronic health record (EHR) portal reminders. The interventions were tested through randomized controlled trials embedded within the EHR system.
The study proceeded in two Plan-Do-Study-Act (PDSA) cycles:
- Cycle 1: Patients due for each screening were randomized to receive either a redesigned reminder for retinal, HbA1c, or mammography screening or the existing standard reminder. The redesigned reminders featured concise messages with direct links enabling scheduling.
- Cycle 2: A follow-up trial focused solely on mammography screening, randomizing patients to receive either a personalized reminder versus the redesigned, non-personalized mammography reminder from Cycle 1.
The primary outcomes were scheduling or completion of the indicated screening test following the reminder.
Results
Cycle 1 Outcomes
The redesigned EHR reminders yielded varied effectiveness across screening types:
- Mammography: Patients receiving redesigned mammography reminders demonstrated significantly higher adherence compared to controls (25/212, 11.8% vs. 13/212, 6.1%; p = 0.04). This reflects nearly a doubling in screening adherence.
- Retinal Screening & HbA1c Testing: No statistically significant differences in adherence were observed between patients receiving redesigned versus standard reminders.
Cycle 2 Outcomes
Among patients randomized to personalized versus non-personalized mammography reminders, scheduling adherence did not differ significantly (p = 0.68), suggesting that personalization of the message content did not enhance effectiveness beyond the redesigned standard reminder.
Expert Commentary
This study provides practical insights into how electronic preventive care reminders can be optimized within real-world healthcare systems. The significant improvement in mammography adherence underscores the potential of brief, actionable messages linked directly to scheduling workflows to reduce barriers to care. The lack of effect for retinal and HbA1c reminders may reflect differences in patient motivation, complexity of screening logistics, or competing demands, highlighting the need for tailored approaches for different preventive services.
Importantly, the lack of incremental benefit from personalization aligns with emerging evidence advising simplicity and clarity over complex tailoring in patient messaging. These findings are consistent with behavioral science principles that emphasize ease of action and minimize cognitive load.
Limitations include modest absolute adherence rates and conduction within a single health system, potentially limiting generalizability. Additionally, longer-term clinical outcomes were not assessed, and further research should explore combining reminders with other interventions such as clinician engagement or patient navigation.
Conclusion
This iterative, randomized evaluation confirms that behavioral redesign of EHR patient portal reminders can feasibly and effectively enhance mammography screening adherence in a large healthcare system. The study highlights the importance of concise reminders paired with integrated scheduling access as a scalable strategy to bridge preventive care gaps. However, the variable effectiveness across screening types signifies that one-size-fits-all reminder designs may be insufficient, necessitating tailored interventions for complex screenings like retinal exams or HbA1c testing.
Healthcare systems should consider implementing streamlined, behaviorally informed portal messages for breast cancer screening, while investing in further research to optimize reminders for other preventive services.
Funding and Registration
This study was conducted within the NYU Langone Health system. No specific funding source or clinical trial registration was reported.
References
- Krelle H, King WC, Tsuruo S, et al. Bridging the Gap: Portal Messages as a Tool to Improve Breast Cancer and Diabetes Screening Rates. J Gen Intern Med. 2026 Apr 29;41(9):2624-2628. doi:10.1007/s11606-026-42056-7. PMID: 42056367.
- Maciosek MV, Coffield AB, Edwards NM, et al. Prioritizing clinical preventive services: a review and framework with implications for community preventive services. Annu Rev Public Health. 2006;27:341-355. doi:10.1146/annurev.publhealth.26.021304.144437.
- Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med. 2009 Feb;36(2):165-173. doi:10.1016/j.amepre.2008.09.040.
- Vindrola-Padros C, Porzsolt F, Evans J. Effectiveness of electronic reminders to improve adherence to clinical guidelines in primary care: a systematic review. BMC Med Inform Decis Mak. 2021;21(1):9. doi:10.1186/s12911-020-01367-1.
