Is an Oncology electronic medical record system appropriate for your office?
The specificity of the Oncology work flow, terminology, cancer staging, chemotherapy, and high risk associated with chemotherapy administration creates a complexity requiring an EHR/EMR to be much more than a repository of patient information. Due to this complexity and limited market Oncology specific electronic medical record system availability is rather limited. As a result, it is not uncommon to find an oncology practice with a generic EMR and a separate interfaced system(s) for Chemotherapy and Clinical Trials.
Comprehensive Oncology Specific EMR / EHR Features:
- Chemotherapy automation and treatment flow sheets
- Clinical Trial application
- Cancer specific templates
- Procedural templates
- Knowledge base integration and/or links
- Patient education integration and/or links
- Coding and Billing Component
- Flow sheets and screens compatible with work flow
- Laboratory management
- Referral tracking
- Consultant letters
- Radiation oncology
- Cancer Registry
Automation of Chemotherapy administration is a vital component of the EHR / EMR and should address the following:
- Chemotherapy drug orders
- Protocol management
- Dose calculations
- Correct Dosing
One of the greatest safety benefits of an Oncology EMR is obtained by way of Chemotherapy automation. Chemotherapy automation alone provides for enhanced quality of care, limits physician liability, and reduces risk.
Chemotherapy order sets using standard up to date evidenced based protocols is essential and can prevent mistakes. Furthermore, Electronic dose calculation reduces mathematical errors
An EHR/EMR that has been designed specifically for Oncologists will have a variety of Oncology specific content as well as Oncology specific workflow included within the product. An Oncology specific EMR/EHR will most likely be adapted to your own workflow and method of practicing Oncology Medicine. The oncologist would benefit to search for an EMR system with customizable cancer treatment regiment templates. Customizing an established template can save valuable time at the pre-implementation phase of the EHR/EMR project. It is advisable to have the EMR vendor assist with this customization. Another advantage of using customizable templates is that the templates usually will have been based upon national guidelines and provides for a base level of standardization. Specific EMR/HER templates for the most common types of cancer treated should be identified and customized initially. To provide for maximum efficiency and encourage provider utilization, all templates should be accessible with a single key stroke or click.
Rules based ordering for medications, lab test, imaging and other orders built within a template will improve compliance with standards of care and enhance revenue. Protocols and patient regimens can be developed within protocols resulting in consistent patient care.
Decision supported pathways and knowledge base information linked or accessible from templates and or system screens is an added resource for the oncology provider.
Oncology Specific EMR/EHR Templates (Sample listing)
- Breast Neoplasia
- Heart Neoplasia
- Hematological Malignancy Histology
- Human Papillomavirus
- Intracellular Chemotherapeutic Agents
- Lymphoid Malignancy
- Myeloid Malignancy
- Odeontogenic Tumors
- Osseous and Chondromatous Tumors
- Paraneoplastic Syndrome
- Respiratory Neoplasia
- Skin Cancer
- Thymus Neoplasia
- Tumors of lip, oral cavity and pharynx
- Urologic Neoplasia
- Vascular Tumor
Mapping Work Flows and Developing / Customizing Oncology EMR / EHR templates
Screens associated with points of care should be mapped and developed to match the work flow to provide maximum efficiency for the provider and other caregivers.
It is important to provide for single entry of data to maximize efficiency and reduce risk of error. Once a data item is captured during a visit it should flow automatically to the various screens, templates, and fields without entering the data again. As an example, Chemotherapy medications ordered as a part of the chemotherapy template should flow or transfer to medication fields, flow sheets, etc automatically without entering again. It is just as important for static data to flow into the selected template to prevent double entry as well including demographics, allergies, etc.
Procedural templates are other valuable tools for the EMR that can save the oncologist time and eliminate transcription cost. Bone marrow biopsy/aspiration and lumbar puncture are just a couple to consider. Once again it would be important that the procedural templates be customizable and allow for inclusion of speech recognition, transcription, or editing for specific patients as needed.
Other Oncology Specific EMR / EHR Features:
Various reports required by CMS, Registries, etc. should be obtainable. Standards reports should be reviewed for required elements and custom reports should be easily available as reporting requirements are added and changed periodically for both external and internal use.
Cancer Registry data elements should be identified and applicable report should be available to facilitate Cancer Registry reporting automation.
Clinical trials are invaluable to the oncologist and their patients and should be incorporated as a component of the EMR/EHR. The EMR should facilitate documentation of patient enrollment for clinical trials, provide for treatment description, and identify the trial sponsor. The system should provide easy tracking and identification of patients participating in the trial and be available to all caregivers. An optimal system would have a link or integration with the Coalition of Cancer Cooperative Groups, a non-profit organization focusing on cancer clinical research.
There are some sophisticated specific clinical trial systems available and consideration should be given to utilize this type of system building an interface with the EMR for greatest efficiency. This can be advantageous as these systems generally provide connections directly to large regional cancer programs.
Laboratory Considerations for an EHR/EMR product
Interface availability for lab results:
- Major laboratories utilized by the practice and/or contracted by specific patient insurance coverage should be identified and interface availability or development is determined during the selection process. Interfaces that would require development can be costly and should be identified and negotiated early in the process. Failure to have necessary interfaces will result in paper results having to be abstracted into the EMR and/or scanned into thee EMR. Either of these methods increases the risk for error and reduces efficiency of provider reviewing results and retrieving results at a later time.
- A system that has lab processing rules built in reference to insurance contracts or Medicare billing rules can ensure that compliance and billing rules are followed.
- Laboratory routing automation can ensure that the proper studies are sent to the proper lab, with the proper Medicare Compliance issues addressed is a cost saving feature.
- Bar coded Lab labels that automatically print with patient demographics and test orders can help maintain compliance, patient identification and assure correct test is performed.
- Recommended Lab studies identified by protocols built within templates for care and chemotherapy provides for consistent standard of care and improved lab revenue.
- Automation for lab result tracking starting at order entry, resulting, provider review, until notification of patient is provided. This addresses liability insurance and other regulatory compliance issues.
- User friendly flow sheets and screens can capture designated data required for each type of encounter/visit.
- An efficient EMR system will provide ease of access to flow sheets, user friendly screens, and graphs for various identified data items, such as vital signs, lab results, medications, cancer type, cancer stage, clinical trials, and known complications. It is also advisable to have links to website or other resources available on specific care screen allowing the connections to valuable resources, just a click away.
Tracking of medications at the patient, medication, and reaction level facilitates improved patient care and case studies. A system that allows tracking of medication inventory and usage can facilitate automation of medication purchases. Medication reactions and toxicity monitoring utilizing standard adverse reaction terminology is invaluable for reporting, tracking, and follow up.
Documentation regarding nutrition within specific templates or assessments screens can be useful for patients receiving chemotherapy.
Mapping Classification and Procedures
Diagnosis codes and procedure codes included in the structure of the EMR can assist oncologists in classifying and mapping different stages of tumors. Coding integration also will facilitate billing maximizing payments, eliminating missed charges especially in systems utilizing automatic level of service and charge entry.
A system with direct connection for charging and billing improves efficiency and reduced cost associated with billing. Billing alerts that are built within the system can provide assistance in preparing clean billing documents meeting all necessary regulations. A direct billing component reduces the risk for data entry errors that can be costly and possible be associated with billing penalties in some situations.
Education Material and Resources
Direct links to patient friendly education materials and resources that can be accessed with minimal key strokes, and will automatically create a link within the patient care documentation, is an optimal method of documenting in the record patient education.
So, now you have an EMR – No more paper, all digital. That would be the perfect world, but think again: We are not there yet. With all the automation there will still be that paper document that floats its way into the practice and where do you put it? The answer? SCAN IT. The capability to scan a paper document into the EMR is a must, and it is necessary for the EMR to have this capability.
A patient portal t the EMR allows for secure patient access to request appointments, medications refills, receive test results, obtain educational material, update specific predefined data such as demographics, billing, etc. The patient portal can also be utilized as a marketing tool.
In summary, the Oncology EMR should encompass the key components for Oncology medicine to obtain the greatest benefits from an EMR/EHR. Selecting an EMR product which includes the specified components identified as appropriate for an Oncology EMR will provide for the greatest efficiency, accuracy, and quality Oncology Care. Research for the optimal Oncology EMR will be greatly enhanced by use of a check list for the recommended components for the Oncology EMR/EHR.
The most appropriate Oncology specific EMR/EHR software will have the following components:
- Chemotherapy automation with alerts and correct dosing
- Specific Oncology EMR/EHR templates
- Reporting capabilities for both internal and external needs
- Automated cancer registry reporting
- Clinical trial component
- Laboratory result interface
- Automated lab result tracking
- User friendly flow sheets, screens and graphs
- Medication inventory tracking
- Coding integration
- Automation of charging and billing
- Direct link to patient education materials and resources
- Document scanning
- Patient accessibility