The initial capital outlay for transitioning to an electronic health record (EHR) is not small. In fact, cost is one of the main reasons practices have been slow to adopt EHRs. These systems can cost tens of thousands per physician to set up and maintain; thus, the smaller the practice, the more economically daunting the endeavor. While adoption rates at the smaller practices are understandably low, even larger ones aren’t adopting these systems as quickly as the government would like, resulting in some recent incentives being offered, along with some potential penalties if an EHR is not implemented by 2015.
At RadAmerica II, LLC, a wholly-owned, for profit subsidiary of MedStar Health, Inc, which is currently the largest provider of technical radiation oncology services in the Baltimore–Washington region, the decision to adopt an EHR was based on the long-term benefits, including improved care coordination, compliance with impending regulations, and to improve efficiencies in personnel and operating costs. After performing a comprehensive review of the available products, we chose Impac. Our primary driver in the selection process was the company’s breadth and depth of services in the field of radiation oncology; however, multiple vendors have products available for oncology, and, specifically, radiation oncology. Other practices have used different EHR products successfully, so deciding on an EHR really depends on a practice’s needs and means. When we rolled out the Impac EHR, this was done in several phases, and while it was largely successful, we did learn some key lessons along the way.Our rationale for implementing an EHR
• Improved care coordination and increased patient safety
—First and foremost, successful implementation of an EHR improves communication and care coordination among providers. In the radiation therapy field, the EHR will aid in care coordination on two levels—improved communication with outside clinicians and all in-house care providers and time saved in identifying and reviewing patient records. Radiation therapy is one of the major treatment options for cancer patients. It can be used alone or in conjunction with surgery and/or chemotherapy; thus, in many cases, numerous other specialists are involved in caring for these patients.
Radiation therapy itself also involves numerous care providers, including clinicians, nurses, radiation therapists, physicists, dosimetrists, and schedulers. Because so many people are involved, and a patient’s radiation treatment can range from one treatment up to 40, it is important for everyone to be on the same page to prevent errors. This requires constant communication among the many people involved. We’ve found that our EHR has increased communication between different providers, ensuring each patient’s unique needs are addressed and that the best treatment options are identified. Care within the radiation therapy department has also been improved because time is no longer wasted looking for paper charts, allowing more time to be spent with patients.
• Federal regulations
—Federal and state regulations are moving to convert all patient records to an electronic format over the next several years. While we do not know exactly what this will ultimately entail or look like, our approach is to be proactive and not reactive with compliance, especially because these regulations will ultimately benefit the patients we serve.
• Operational efficiencies
—Over the past five years, there have been major advancements in the technology and complexity of treatments delivered. EHRs take these advancements and regimens into account, affording various efficiencies, including:
(1) Connectivity. Imaging, such as CT scanning and MRI, is essential to treatment planning and is needed before radiation therapy can be initiated. Our EHR allows us to import and fuse images, enabling us to create the best plans possible for our patients. These plans are then readily available in the EHR for future reference.
(2) Computerized physician order entry. Our EHR enables automated customizable patient treatment prescriptions. The physicians begin with a template and can modify the template to fit their needs.
(3) Pre-Treatment Quality Assurance. As part of the EHR, validation of a patient’s treatment plan occurs in a separate component of the electronic system; thus, only after the dose is validated and actually delivered, does it become recorded in the patient’s medical record.
(4) Patient positioning. Positioning technology is built into our EHR to assist with patient positioning during treatment. We can also perform trend analyses across multiple patients and modes of technology.
Benefits of EHRs
Clearly, implementing an EHR is an investment in the future; however, several benefits can be quantified at the outset, some of which have monetary value. What follows are some of the immediate benefits: