Andrew D. Schechtman

All Publications

• Nested order panels for adult primary care modestly improves ordering efficiency among high utilizers. JAMIA open Schechtman, A. D., Kling, S. M., Garvert, D. W., Lin, J. Y., Shanafelt, T., Winget, M., Sharp, C. 2026; 9 (1): ooaf161

  Abstract

  Objectives: Electronic health record (EHR) order preference lists and order sets potentially improve efficiency but have limited utility in complex primary care settings. We assessed adoption, impact on ordering efficiency, and clinician perceptions of a comprehensive set of nested order panels (xOrders) for adult primary care.Methods: In Phase 1 (gradual implementation), 404 xOrders were released (November 29, 2020-September 25, 2021). Beginning of Phase 2 (rapid implementation), 630 xOrders were released with an additional 253 xOrders added (September 26, 2021-June 24, 2023). Three outcomes captured adoption: xOrders used per week; number of clinician users per week; and percent of xOrders of all orders. Impact of xOrders on times in orders per encounter per clinician was evaluated with mixed effects interrupted time series. t-Tests evaluated differences between low, moderate, and high utilizers. A survey captured clinicians' perceptions in November 2022.Results: xOrders were used 536 (SD, 245) times/week and by 57(15) clinicians/week in Phase 2. xOrders as a percent of all orders ranged from 0% to 31% across clinicians. Time spent in orders per encounter decreased by 14±5s (P=.01) from Phase 1 to 2 for high utilizers, decreased by 7(3)s (P=.05) for moderate utilizers, and increased by 1(3)s for low utilizers (P=.81); low and high utilizers were significantly different (P=.02). Most (77%) survey respondents agreed that xOrders improved ordering efficiency.Discussion and Conclusions: Despite yielding time savings and positive clinician feedback, the xOrder intervention showed limited adoption and impact, suggesting the need for expanded content and increased adoption to realize larger efficiency gains.

  View details for DOI 10.1093/jamiaopen/ooaf161

  View details for PubMedID 41705224

• The Role of Primary Care Providers in Lung Cancer Screening: A Cross-Sectional Survey CLINICAL LUNG CANCER Wong, L., Kapula, N., Kang, A., Phadke, A. J., Schechtman, A. D., Elliott, I. A., Guenthart, B. A., Liou, D. Z., Backhus, L. M., Berry, M. F., Shrager, J. B., Lui, N. S. 2025; 26 (1): 39-44

  Abstract

  Multidisciplinary lung cancer screening (LCS) programs that perform shared decision-making visits (SDMV) and follow up annual low dose computed tomography (LDCT) have been emerging. We hypothesize that primary care providers (PCPs) prefer to refer patients to LCS programs instead of facilitating the screening process themselves.This is a mixed-methods, cross-sectional study in which an online survey was administered to PCPs between April 2023 and June 2023.58 PCPs in the same hospital network participated in the study with a median age of 43 (34-51), predominance of women (77.6%), and clinicians of white and Asian race (44.8% and 48.3%). Respondents estimated that 26.1% (SD 32.4%) of their eligible patients participate in LCS screening. PCPs thought that an LCS program was equally convenient to performing screening themselves for identifying eligible patients and ordering LDCT. However, 63.8% of participants preferred an LCS program for performing SDMVs, 62.1% for ensuring annual follow-up on negative LDCTs, 70.7% for deciding next steps on positive LDCTs, and 60.4% for performing smoking cessation counseling. PCPs agreed that an LCS program saves time (69%), allows patients to receive specialty care (65.6%), addresses patient concerns (70.7%), ensures annual follow-up (77.6%), and manages abnormal findings (79.3%). However, they also expressed concerns about an additional visit for the patient (48.2%) and patient cost (46.5%).Most PCPs believe that formal LCS programs have many benefits including providing specialized care and follow up, although there were concerns about patient time and cost.

  View details for DOI 10.1016/j.clc.2024.10.002

  View details for Web of Science ID 001399860100001

  View details for PubMedID 39472235

• The Role of Primary Care Providers in Lung Cancer Screening: A Cross-Sectional Survey. Clinical lung cancer Wong, L. Y., Kapula, N., Kang, A., Phadke, A. J., Schechtman, A. D., Elliott, I. A., Guenthart, B. A., Liou, D. Z., Backhus, L. M., Berry, M. F., Shrager, J. B., Lui, N. S. 2024

  Abstract

  Multidisciplinary lung cancer screening (LCS) programs that perform shared decision-making visits (SDMV) and follow up annual low dose computed tomography (LDCT) have been emerging. We hypothesize that primary care providers (PCPs) prefer to refer patients to LCS programs instead of facilitating the screening process themselves.This is a mixed-methods, cross-sectional study in which an online survey was administered to PCPs between April 2023 and June 2023.58 PCPs in the same hospital network participated in the study with a median age of 43 (34-51), predominance of women (77.6%), and clinicians of white and Asian race (44.8% and 48.3%). Respondents estimated that 26.1% (SD 32.4%) of their eligible patients participate in LCS screening. PCPs thought that an LCS program was equally convenient to performing screening themselves for identifying eligible patients and ordering LDCT. However, 63.8% of participants preferred an LCS program for performing SDMVs, 62.1% for ensuring annual follow-up on negative LDCTs, 70.7% for deciding next steps on positive LDCTs, and 60.4% for performing smoking cessation counseling. PCPs agreed that an LCS program saves time (69%), allows patients to receive specialty care (65.6%), addresses patient concerns (70.7%), ensures annual follow-up (77.6%), and manages abnormal findings (79.3%). However, they also expressed concerns about an additional visit for the patient (48.2%) and patient cost (46.5%).Most PCPs believe that formal LCS programs have many benefits including providing specialized care and follow up, although there were concerns about patient time and cost.

  View details for DOI 10.1016/j.cllc.2024.10.002

  View details for PubMedID 39472235

• Developing a Telemedicine Curriculum for a Family Medicine Residency. PRiMER (Leawood, Kan.) Ha, E., Zwicky, K., Yu, G., Schechtman, A. 2020; 4: 21

  Abstract

  Introduction: Telemedicine has rapidly become an essential part of primary care due to the COVID-19 pandemic. However, formal training in telemedicine during residency is lacking. We developed and implemented a telemedicine curriculum for a family medicine residency program and investigated its effect on resident confidence levels in practicing telemedicine.Methods: We designed a process map of the telemedicine visit workflow at the residency clinic to identify key topics to cover in the curriculum. We created a live 50-minute didactic lecture on best practices in telemedicine, along with a quick-reference handout. We distributed pre- and postintervention surveys to current residents (N=24) to assess the effect of the educational intervention on their confidence in practicing telemedicine.Results: Fourteen residents (58% response rate) completed all aspects of the study including both surveys and participation in the educational intervention. Confidence levels in conducting telemedicine visits increased in three of five domains: (1) virtual physical exam ( P=.04), (2) visit documentation (P=.03), and (3) virtually staffing with an attending ( P=.04). Resident interest in using telemedicine after residency also increased following the educational intervention.Conclusion: Telemedicine requires a unique skill set. Formal education on best practices improves resident confidence levels and interest in practicing telemedicine. Primary care residency programs should incorporate telemedicine training to adequately prepare their graduates for clinical practice.

  View details for DOI 10.22454/PRiMER.2020.126466

  View details for PubMedID 33111048