• Health systems, especially those caring for medically underserved populations, should consider a multi-level approach to patient and stakeholder engagement to advance adoption of population screening as guideline-based care.
• Iterative engagement should inform design and activation of an electronic order set to (1) capture socio-demographic data to establish screening eligibility, and (2) provide CMS-mandated documentation of patient counseling, while minimizing order burden for referring clinicians.
• Patients who most stand to benefit from guideline-based lung cancer screening may also be those least likely to complete the multi-step processes of screening.
Keywords: EHR; Lung cancer screening; Population-based program safety-net; Smoking cessation; Stakeholder engagement.