Testing
Pre-appointment EHR messages to providers more than triple Lp(a) test orders in a US community health system (Am J Prev Cardiol 2025)
Original title: Increasing provider awareness of Lp(a) testing for patients at risk for cardiovascular disease: A comparative study
In a prospective comparative study at a large US community health system between December 2022 and March 2023, providers randomised to receive a pre-appointment Epic EHR message about Lp(a) screening ordered more Lp(a) tests than providers who did not (16.6% vs. 4.7%, P < 0.001), and more tests were completed as a result (10.2% vs. 3.7%, P < 0.001). Nurse practitioners and physician assistants had the highest per-order completion regardless of messaging. Among patients tested, 30.6% had Lp(a) at or above 50 mg/dL. A simple point-of-care nudge meaningfully raised guideline-recommended Lp(a) testing, though the underlying testing rate remains low.
Original abstract
Background: Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients.
Objective: To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider.
Methods: From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2).
Results: Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, P < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, p < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order (Z = 16.40, P < 0.001), achieving 30.8-39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL.
Conclusion: Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.