Navigating the EHR marketplace can be dizzying, with numerous products available to choose from, including locally installed client/server systems that require server hardware, local networks, data backup, and IT support, as well as hosted, Web-based systems. Although most platforms are built on the presumption that physicians will pay for the EHR, some follow other business models, resulting in low-cost or even free opportunities. With a myriad of options available, you may wonder how to determine which system is right for your oncology practice. Should you pick a general-purpose EHR that has oncology modules added on or an EHR that is designed specifically for oncology practices? Regardless of which of these you choose, there are several key general and oncology-specific features you should be looking for. Let’s examine these features to make your experience shopping for an EHR less daunting.General features
Physicians have many workflow patterns in common, regardless of specialty. The following general features are essential to keep any practice running smoothly, so be sure any EHR you consider offers them:
• Ability to create chart notes easily using specialty-specific templates, preventing you from being slowed down by cumbersome data entry tasks. Ideally, the system should enable dictation/transcription and free-text typing and provide templates that can minimize typing.
• Capability to integrate billing, either as an in-the- product billing application or the electronic equivalent of generating a superbill as a message transmitted to a biller.
• Availability of electronic prescribing, which is becoming increasingly important now that CMS is placing a bonus on services rendered by practices using electronic prescribing.
• Capacity to create and maintain diagnosis lists, medications lists, and refill histories, whether by electronic prescribing, written prescriptions, samples given, or parenteral medications administered.
• Ability to access records remotely.
If all of the EHRs you are entertaining provide these features, another distinguishing general feature you can look for is the ability to write reports to referring physicians or others involved in the care of complex patients. This feature may be especially useful to oncology practices, where patients often require multidisciplinary care.Oncology-specific features
Some of the workflows oncologists experience are unique to this specialty. The following oncology-specific features can help meet some of the specific needs encountered in an oncology practice:Detailed diagnosis support
When a cancer diagnosis is made, there are several “auxiliary” elements that need to be associated with it, including tissue type (the ICD9 number), TNM classification and staging, and, in some cases, tumor grade. Ideally, an EHR should have a tumor-specific algorithm that allows quick specification of T, N, and M, and suggests a stage based on the results. There should also be a variable or free-text way of including additional descriptors, such as genetic markers, which will vary from cancer to cancer. Once this is specified, links should be generated that point to the most current treatment options available.Decision support
Decision support at the point of care is one of the most important functions that a good EHR can provide, as evidence-based algorithms for the treatment of cancers are evolving rapidly. An EHR needs to be able to point you to the most current data, rather than trying to include them in the product itself, which would render them obsolete from day one. The EHR should also be able to automatically point to a list of resources based on tumor type and stage, TNM classification, and grade, and the generated resource links should be automatically assembled so that “chasing down” links through a succession of clicks is minimized. Ideally, these links would also include the most current data on any available genetic-marker testing, including any evidence showing some or no impact on outcome, both of which may be relevant to decision making.
The array of treatment protocols appropriate for a given cancer and stage, along with any other appropriate markers, should be displayed via a link to trusted reference sources. Such access to the ever-evolving data is essential for optimizing patient care, reducing treatment variability across the oncology landscape, and minimizing liability.
Chemotherapeutic agents must be monitored much more aggressively than medications commonly prescribed in the ambulatory, go-to- the-pharmacy setting. A good EHR will offer more than drug–drug interaction warnings; it will also provide you with dosing, duration, and frequency of medications and infusions, which are heavily influenced by laboratory findings. Ideally, the EHR would prompt you on a patient’s lab findings and automatically adjust the regimen accordingly. At the very least, links to resources should be provided.