How Does IT Affect Quality of Care?

Patrick Cobb, MD, FACP, and Cathy Bealer, RN, MHA
Published: Thursday, Dec 11, 2008
Oncology practices across the country are using computer technology to improve outcomes and quality of care for our patients.

The development of relatively inexpensive computers and the Internet has given us the ability to change more than the way we buy airline tickets, obtain entertainment, and order T-shirts. The adoption of three technologies in particular—electronic medical records (EMRs), telemedicine, and patient-reported symptom monitoring—have had a profound effect on the quality of care provided by oncologists.



EMRs

EMRs are touted as being essential to oncology practices. Practice consultants, healthcare systems, some private payers, and even the federal government are all saying it’s time to move to a computer-based information system. And they’re probably correct. Delivery of cancer care is a complex and potentially high-risk process, and it makes sense to take advantage of the abilities of powerful computers to facilitate oncology practice. Implicit in this technology’s advancement is the potential to improve the quality of care for our patients through increased efficiency and standardization of treatments.

Three years ago, after much research and debate, we decided to purchase an EMR system for our practice in Montana and Wyoming. We became convinced that the potential benefits of a paperless electronic record would outweigh the cost and hassle of implementation. As one partner put it, “we drank the Kool-Aid,” and launched into the brave new world of EMRs.

We wanted our EMR system to facilitate standardization of practices across our four offices. We hoped that the promise of developing a “best practice” for chemotherapy regimens would lead to consistant treatment, more predicatable treatment costs, and ultimately, better outcomes for our patients.

For example, we agreed to standardize common chemotherapy regimens, such as R-CHOP for non-Hodgkin lymphoma. The oncologists agreed to give the same antiemetics, supportive care drugs, and doses of chemotherapy agents based on the best evidence in the literature. Physicians are free to change the regimen if there is a clinical reason for a variation, but the point-and-click nature of ordering a chemotherapy regimen makes it easy to adhere to the guidelines.

Setting up these chemotherapy care plans was a Herculean task. The software came with pre-loaded care plans, but we found it still took many hours of research, multiple meetings among the physicians and nurses, and lots of computer programming time to customize these protocols to fit our practice.

Our practice later joined Cancer Clinics of Excellence (CCE), a group of practices that has agreed to collaborate in order to improve cancer care for our patients. CCE has developed a large set of evidence-based treatment protocols (ETPs) that address best practices for most of the diseases we treat. Our EMR system has the potential to facilitate these ETPs in our care plans, and we are currently working toward that goal.

The EMR has improved code capture and somewhat streamlined our billing process. Because charges for chemotherapy drugs are automatically linked to the system, we have found that we no longer miss billing for our very expensive drugs. Bills are sent to insurance companies faster, and our days of accounts receivable dropped by almost 10 days after we implemented the system.

In these days of shrinking chemotherapy drug margins, it is vital to track utilization of drugs and services. The EMR makes this much easier than our previous system. Some authors have written that this type of information can help in negotiating with payers for better payment rates, and we are partnering with CCE to come up with a way to do just that.

Pharmaceutical companies are very interested in studying utilization data for different disease states, and they contract with companies to abstract that information from practices. Before installing the EMR system, our personnel were required to pull charts, making them unavailable for clinical use, and deliver them to the reviewers who took up a room in our office. Now the abstractors are able to do anonymous chart reviews from a remote location without disrupting our patient care. Needless to say, we are much more willing to participate in these chart reviews, and it has created a source of revenue for our practice.

Our practice has always had a large commitment to clinical research, reasoning that participation in trials ensures that our patients receive state-of-the art treatment and improves overall quality of care. The EMR system facilitates that in several ways:

• Our research assistants are able to screen new patients’ records to see if they may be eligible for one of our trials, even while the patient is being seen by the oncologist.

• The treatment regimens and follow-up visits are pre-loaded into the system, making compliance with the protocol simpler for the physicians.


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