True integration of cutting-edge care and timely translation of information from the bench to bedside requires an oncology practice to have knowledgeable physicians and a “toolbox of technology.” EMRs and algorithms for understanding risks of recurrence and benefits of therapy are examples of two such tools.
Although many clinicians view implementing technology as a significant challenge, it is also an opportunity to enhance ease of care and safety, while also capturing a wealth of data for quality-of-care and billing analysis. Electronic records enhance efficiency by eliminating the need to search through paper charts. Each patient’s complete medication information is available with the click of a mouse. Oncologists can update the medication history and then check for allergies when ordering the next round of chemotherapy.
The clinician’s time and the patient’s journey should be the key drivers for developing and implementing a truly patient-centered, meaningful IT application. The goals of health IT must be to enhance efficient patient care through better documentation, clinical research, ease of retractable information for reporting outcomes, or other needs for data extraction as a byproduct of workflow.IT implementation
IT needs must be driven by processes rather than product availability. The “big picture” of the patient journey and IT skills of all staff involved are also important variables; focusing on them as well as on physicians to drive technology adoption will help ensure success. A proactive implementation team that trains staff is another key to ensuring a smooth implementation.
There are many schools of thought regarding implementation (eg, “big bang” vs. a phased approach). With the big bang, you feel the “pain” all at once, but at least everyone is on the same platform and all the information is now in the same place. This approach helps you avoid the trap of having some areas of a practice relying on paper records while others are forced to use incomplete electronic records. Process-based, stepwise, phased implementation can be a less overwhelming approach. But this “stuck in two worlds” approach means you are never sure if all of a patient’s information is included in the electronic record—was it missed, or was it put on paper, or did someone mean to enter it in the computer and just forget? This complicated process requires an effective plan for implementing equipment and coordinating staff training. The plan must also include a timeline that specifies how long you want each phase to run before the next phase goes live.
For both approaches, you need to plan very carefully on how you will train each area of the practice. “Super users” who train and support the rest of the staff are very helpful. You will need to have a project manager who coordinates the project and decides what and how many servers are needed, what type of hardware to order, and go-live timelines with testing and training included. Clinical informatics and technical support are keys to this process. IT support must include hardware support (if someone cannot turn on the computer, does not have access to the correct drive, needs Internet access, needs a printer installed, cannot print, etc) and clinical support (if someone cannot log into the clinical application, cannot access the correct screens, or does not have the correct screens).
Inadequate training—both prior to “going live” and post implementation—can result in frustration. The staff will naturally be nervous about using a new electronic record—whether they are proficient with computers or not— and if they cannot access the appropriate applications or screens, their frustration level will skyrocket. Simple things like not being able to print or find the weight field on a screen will send them into overdrive.Improving efficiency and quality with CPOE
Once implemented, these tools can help deliver safer care and improve practice efficiency. Many EMR vendors assist healthcare providers with well-constructed clinical screens and safety alerts, such as best practice alerts (BPAs). BPAs appear on the screen to remind providers to order the appropriate medications or place the patient on the appropriate protocol. Electronic systems (including CPOE) also provide soft and hard stops for patient assessments or incomplete billing orders. The stops will not allow users to move to the next screen unless the fields are populated.
The Centers for Medicaid and Medicare (CMS) has released the latest set of Physician Quality Reporting Initiative (PQRI) measures that require physicians who have opted to participate to report specialty-specific performance measures to receive incentive bonuses. These measures are pre-defined and captured on the patient’s bill, and must therefore be clearly indicated on the patient’s record and in the final diagnosis and coding. The electronic record allows providers to consistently document the patient’s condition, diagnosis, and treatment plan, along with any necessary measures and codes needed for PQR that can be entered during the patient’s visit.