Tag Archives: practice improvement

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.

A Survivorship Roadmap Linked to EMRs

By Don Jewler, Guest Blogger

2014_InnovatorLogo finalIn a perfect world each patient who has recently completed cancer-directed therapy should receive a survivorship care plan that clearly summarizes his or her treatment and provides direction on what to expect in the next several weeks, months, and years of their life to come. That survivorship plan should be available in print form as well as easily accessible electronically on a patient web portal.

Oncology Specialists, SC, in Park Ridge, Ill., did exactly that. What’s more, they developed their survivorship care plan with the idea of incorporating many of the information points that are already collected within the patient’s electronic medical record (EMR) that essentially self-populates into the plan. The plan provides a treatment summary, including side effects, as well as health maintenance issues and the impact of cancer diagnosis on the well-being of family members.

Oncology Specialists, SC, will be honored with a 2014 ACCC Innovator Award for its EMR-driven approach to survivorship care plans.

“The impetus for development of the survivorship plan was a mandated change in the Commission on Cancer standards,” said Mary Beth Mardjetko, RN, MN, administrative director.

Standard 3.3 (a 2012 standard that must be phased in for 2015) states that the cancer committee must develop and implement “a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment.”

Initially, after reading Commission on Cancer (CoC) requirements, Mardjetko and others in the oncology practice were worried. With limited resources and time, how could they put together a survivorship plan for all their patients?

“We saw 40-page survivorship plans. We knew these would not be realistic in our practice. So, a small group consisting of a physician, three nurses, and myself looked at the CoC requirements,” said Mardjetko. “We decided to use the template function of the EMR and build a generic survivorship plan that would be individualized for each patient using information that would pull directly into the note. We developed a four- to six-page survivorship plan with the CoC standards as the guide.”

Those standard elements include a treatment summary, drug names, doses, side effects, and names of all physicians and supportive care personnel involved. A treatment plan for years one to five is provided, as well as long-term outlook and recommendations, such as genetic testing for first-degree relatives.

Since nurses and physicians constantly update the EMR, the survivorship plan is dynamic and versatile. It can easily be sent to the primary care physician or other physicians involved in that patient’s care.

“The most wonderful part was how grateful patients were for learning what was to come next—what they could expect now and in the future,” said Mardjetko. “Physicians and nurses found the experience wonderful, too, as they went over the survivorship plan with patients and provided closure at the end of treatment.”

The next step is for Oncology Specialists, SC, to work out a survivorship plan for patients who are metastatic or on oral therapies.

“This is still a work in progress,” said Mardjetko.

Want to learn more? Join us at ACCC’s upcoming 31st National Oncology Conference in San Diego, October 8-10. Sigrun Hallmeyer, MD, medical director, Cancer Survivorship Program, Oncology Specialists, SC, Advocate Lutheran General Hospital, will provide more details. And check out a video about the survivorship plan here.

ACCC members will recognize the byline of guest blogger, Don Jewler, former ACCC Communications Director. We coaxed Don out of retirement to contribute to ACCCBuzz.