Tag Archives: electronic health records (EHRs)

EHRs (Expensive. Hideous? Required!)

By Amanda Patton, ACCC Communications

Resonating across sessions at last week’s 34th ACCC National Oncology Conference: EHR issues. One sentence takeaway: As data collection and reporting requirements multiply, the ideal oncology EHR solution remains elusive.

Here’s a snapshot of what we heard during Friday’s panel discussion on “Strategies for Optimizing Your EHR”: the good, the bad, and, yes, the getting better.

Control, or lack thereof. Sometimes a cancer program or practice has successfully tailored their EHR to meet their operational, programmatic, and reporting needs—only to have the health system or hospital opt for a completely new system.

Interoperability. While Friday’s panel discussion revealed some steps to successful EHR utilization for reporting, panelists also spoke about ongoing challenges, including having to work with several EHRs on a daily basis. “Multiple EHRs require a lot of flexibility, especially for oral medications,” said panelist Linda Frisk, PharmD, Arizona Oncology Associates, PC.

Too many portals. Oncology staff may use three different EHRs on a daily basis, plus some additional portals, for example, for specialty pharmacy. For providers, this can result in “password overload,” commented panelist Rachel Lawlor, MHA, RN, OCN, Cancer Care at Mosaic Life Care.

“Very labor intensive process.” This phrase cropped often during conference sessions–not just during Friday’s panel discussion–usually in reference to ongoing struggles to extract some types of data for reporting. In some instances, at least some data extraction is still a manual effort.

Provider compliance. Although several recent studies point to EHRs and increased “box checking” as contributing to physician burnout, panelists agreed that physician buy-in is critical to optimizing EHR utilization. “You really need to get buy-in from physicians,” said Judy Stone, CMPE, Stamford Hospital.

To get the most from your EHR, “make sure your physicians are filling in queryable fields. Make sure all the data that we can query is in there,” said Linda Frisk, PharmD. One example of leveraging EHRs to improve patient care: the ability to query ‘KRAS’ and have all the progress reports with KRAS come up.

Oncology is different. “It is simply critical to make your IT department aware of what a cancer center does and how very different we are from other divisions of the hospital and other outpatient departments,” said Judy Stone, CMPE. If your IT department doesn’t know what oncology does, invite them to observe for a day or two.

Here to stay. Data collection, analytics, and quality reporting are key requirements as healthcare moves away from fee-for-service into the value-based care environment. “Reporting quickly, efficiently, and in a way you can understand will be critical for our future,” said Linda Frisk, PharmD. EHR optimization should ultimately result in more accessible data to use both operationally and for quality reporting, and demonstrate value. “I think patients want to see value,” she said.

But wait, there’s more.  In conjunction with Friday’s panel discussion ACCC released a new resource, Optimizing Your EHR: Real-World Experiences with Electronic Health Records, which includes practical peer-to-peer tips for getting the most from EHRs to improve patient care, plus strategies to overcome common hurdles and challenges.

Visit the ACCC website here for more from the recent 34th ACCC National Oncology Conference.

The Journey to EHR Optimization

Second in a two-part series from ACCC’s Optimizing Electronic Health Records project. Read part one.

By Joseph Kim, MD, MPH, MBA

While the vast majority of oncology clinicians use an Electronic Health Record (EHR) today, many continue to struggle with poor usability and increased workloads. Recognizing the needs in the community, the ACCC Optimizing Electronic Health Records (EHRs) education initiative aims to identify practical solutions and effective practices to help cancer programs navigate their ongoing journey with EHRs.

ACCC convened two focus groups for this project bringing together a diverse group of stakeholders to talk frankly about how their cancer programs are overcoming some of the common EHR challenges that hinder provider efficacy.  Four key themes emerged during these conversations, read on.

Coordination of EHRs Across Multiple Locations
Given that some cancer programs span multiple locations that offer different services, it remains critical for all the sites to share patient information effectively. However, even when the sites are all using the same EHR, flawless interoperability is not guaranteed since some hospitals may be running different versions of the same system.  As a result, clinicians who work at multiple locations may need to get accustomed to different screen layouts when they log in, or they may have access to different functionalities based on the customizations that exist at each local site. Moreover, the use of certain add-on modules (e.g., Epic Beacon module for medical oncology) may not be consistent across the health system. Ample opportunities remain to standardize the digital workflow across health systems so that clinicians can work more efficiently.

Another common barrier in the community is the lack of interoperability across the systems used by medical oncology, radiation oncology, pathology, radiology, and the hospital. While some health systems are consolidating to a single EHR system across all those departments and services, many still run into challenges with read-only access versus the need to log in to different computers to access patient records. While establishing local interoperability within the same health system remains an ongoing journey, some regions are also actively leveraging solutions offered by the Carequality Interoperability Framework or the CommonWell Health Alliance to achieve interoperability more rapidly.

Data and Reporting
When clinicians switch to a new EHR system, data migration is one of the biggest time-consuming tasks because of the complexity of mapping all the structured data fields from one system to the next. Cancer programs with access to a dedicated informatics specialist can make customizations and run reports with greater ease. Since oncology is changing at a faster pace than any other medical specialty, cancer programs with access to the necessary IT resources are having an easier time offering new therapies and monitoring patients effectively.

While the cancer registry is usually its own separate system, registrars may provide valuable feedback about data fields and automated reports. Cancer programs participating in programs like the ASCO Quality Oncology Practice Initiative (QOPI) or the CMS Oncology Care Model (OCM) have made considerable investments to generate ongoing reports from their EHRs, so other cancer programs may learn from those experiences and adopt similar approaches within their own institutions.

Building Order Sets
By now, most cancer programs have an established process for creating new electronic order sets and treatment plans for new drugs and therapies. They may have a core multidisciplinary team that meets to create and test new treatment protocols. An oncology pharmacist is an essential member of that team, providing guidance around drug dosing and safety alert parameters. Nurses can also provide important input regarding clinical documentation around safety monitoring. Since order sets for oral oncolytic agents need to be linked between the medical oncology EHR and the pharmacy systems, it remains critical to map how orders are transmitted to different specialty pharmacies that dispense those medications. In some cases where those systems are not integrated, redundant workarounds may be required for the e-prescribing of oral agents.

Superusers may either be formally designated or informally recognized as tech-savvy clinicians who are willing to play a greater role to help their colleagues and peers use EHRs more effectively. In some cases, superusers may carry over from a recent implementation of a new system. It’s important for cancer programs to maintain and foster a group of superusers who can lead the development of new order sets, help to train new users, and provide input on new releases or customizations to the system. Some cancer programs invest in their superusers by sending them to annual corporate training events so that they can also learn how other health systems are tackling common problems and issues. Be sure to give recognition to the superusers because some may take on more formal roles such as Director of Informatics or Medical information Officer.

Look for more insights from the ACCC Optimizing Electronic Health Records initiative in the coming months.

Guest blogger Joseph Kim, MD, MPH, MBA, is serving as a consultant for the ACCC Optimizing Electronic Health Records (EHRs) initiative.  Dr. Kim is President of Xaf Solutions.

Challenges to EHR Optimization for Cancer Programs—Workload, Cost, and Interoperability

By Joseph Kim, MD, MPH, MBA

While electronic health records (EHRs) remain a necessary component of care delivery, in a recent survey of ACCC Cancer Program members, 62% of respondents report that EHRs have increased the workload of their staff and 51% indicate that their EHR system has increased their total operating costs. Only 34% of respondents said that both medical and radiation oncology practices can interface with the hospital system. And about one-quarter (27%) report that neither medical nor radiation oncology practices can interface with the hospital system.

The survey was conducted for the ACCC Optimizing Electronic Health Records (EHRs) education initiative, which aims to help cancer programs identify ways to optimize their EHRs to meet the growing demands for accurate, integrated, comprehensive data capture and analysis.

ACCC conducted the survey (n=98) in early 2017 to assess members’ experience with their EHRs; 70% of respondents represented community cancer programs, 17% were from academic programs or NCI-designated cancer centers, and 11% were from outpatient oncology practices.

Among survey respondents the most common EHR systems in use were Epic and Cerner.

  • 47% have been using their current EHR system for more than 5 years.
  • 26% are actively switching to a different EHR system (either to Epic or Cerner).
  • The most common reasons for switching:
    ♦ To standardize EHR use across the entire health system
    ♦ To Increase data extraction and reporting capabilities.

While some EHR systems come with optional packages and add-on modules, others require their users to install third-party software.  According to survey responses, the most common add-on software packages are currently being used for:

  • Billing and coding
  • Survivorship care plans
  • Patient engagement and communication via patient portals.

In the current landscape, interoperability even within the same system remains a significant challenge. Specifically:

  • Only 34% of respondents indicate that both medical and radiation oncology practices can interface with the hospital system.
    ♦ 22% indicate that only medical oncology interfaces with the hospital system.
    ♦ 9% indicate that only radiation oncology interfaces with the hospital system.
  • 27% report that neither medical nor radiation oncology practices can interface with the hospital system.

The survey also asked respondents to rate different usability factors. Those receiving the highest ratings (i.e., most usable) were:

  • Entering patient information
  • Searching for medical information about a patient
  • Interfacing with the patient portal

The usability factors with the lowest ratings (i.e., least usable) were:

  • Ability to incorporate third party add-on modules
  • Customer service provided by EHR vendor
  • Making customizations within the EHR

Cancer programs rely heavily on their designated superusers, who often train new users, to provide recommendations or test new releases. Responses in several survey areas indicate that the increased use of scribes (also called clinical documentation specialists) may be a growing trend, especially for certain providers who may benefit substantially in their ability to see more patients.

Through this project, ACCC will be identifying real-world examples of how community cancer programs are optimizing their use of EHRs. Stay tuned for more project updates here.

Coming next, see what a focus group of ACCC members reveals about real-world challenges to EHR optimization.

Guest blogger Joseph Kim, MD, MPH, MBA, is serving as a consultant for the ACCC Optimizing Electronic Health Records (EHRs) initiative.  Dr. Kim is President of Xaf Solutions.