The mantra in oncology over the last several years has revolved around how practices should deal with the myriad of challenges they face: new guidelines and regulations, lower reimbursement and a shift toward value-based patient care.
The mantra in oncology over the last several years has revolved around how practices should deal with the myriad of challenges they face: new guidelines and regulations, lower reimbursement and a shift toward value-based patient care. As a result, many community oncologists are actively looking for opportunities to improve efficiency within their practices, lower costs, and ensure their practices remain financially healthy and independent. As exciting new therapies and drugs bring hope to patients and remind oncologists why they chose their field, new information technologies are also changing the game when it comes to operating a practice. In fact, through these challenging and exhilarating times in cancer care, one thing has become clear: innovative healthcare information technology can play a critical role in helping physicians provide high-quality, evidence-based, cost-effective patient care.
Electronic Health Record (EHR) systems are one example of technology that can help practices meet many of their clinical and operational goals. While there has been a great deal of talk about EHRs over the last couple of years, due in part to the financial incentives offered by the Centers for Medicare & Medicaid Services (CMS), many practices still have not yet taken the plunge. As more practices consider adopting an EHR for the first time or even switching to a new EHR, there are several important factors to consider:
Healthcare Information Technology, including EHR systems, needs to be designed to drive outcomes and quality care. For oncologists, that means choosing an oncology-specific EHR that includes meaningful content relevant to oncology and clinical decision support tools available at the point of care. Oncology-specific tools will best help oncologists provide and measure value-based patient care.
One key to ensuring the technology offers relevant content is the inclusion of oncologists as an integral part of the software development team. These physicians can draw from their day-to-day clinical experience to create a system that integrates into daily oncology workflow. Oncology can require specialized and complex treatments. When EHR developers recognize the impact that immediate access to a regimen library and available clinical trials have on a physician’s ability to quickly and accurately make the best treatment recommendations to patients, the result is a combination of systems that work together to offer extensive support to the oncologist at the point of care. One component is a robust decision support engine that prompts the oncologist to answer questions relevant to a patient’s particular type of cancer, and based on the information provided, automatically calculates and recommends the most appropriate stage according to the American Joint Committee on Cancer’s (AJCC) staging criteria. The most robust EHRs will use this information to identify appropriate, up-to-date diseasespecific regimen treatment options and even clinical trials, if available.
An EHR should be interoperable to ensure the system is effectively meeting changing technology needs. When choosing an EHR, a practice should be sure the system will be able to communicate with other systems within the practice—such as practice management and inventory management systems—as well as be flexible enough to exchange information with patients’ other care providers, including hospitals and labs, for the most effective and comprehensive care. Even more, make sure the system was developed on a platform that will accommodate changes and advancements in the future. An EHR needs to stay on top of today’s rapidly changing environment with software that reflects the latest advancements in healthcare and technology.
Oncologists are best served by an EHR optimized for access through a variety of mobile devices, including laptops, tablets, and smart phones. Let’s face it, in today’s mobile world, oncologists must be able to access patient information, quickly respond to questions, and communicate with patients and other care providers whenever and wherever they are.
For many oncologists and practice administrators, the thought of migrating to an EHR system is a doubleedged sword. On the one side, they want to take advantage of the benefits an oncology-specific EHR will provide for the practice and its patients. On the other side is the realization that implementing a new system is a big undertaking.
There are several keys to successful implementation of an EHR: detailed planning; clinical engagement; development of optimal workflows; thorough training of all physicians and staff; and active support throughout the process. To begin, a practice should create a team that oversees the selection and implementation of the EHR and monitors the progress toward meeting Meaningful Use objectives. A good EHR vendor will have an experienced and knowledgeable team that understands the nuances of the way an oncology practice operates and can minimize the disruption to patient care and workflows during the transition. Before selecting an EHR vendor, it’s a good idea for a practice to speak with a few of the vendor’s current customers to ascertain how long the implementation took and the problems they may have encountered.
When a practice has successfully implemented an oncology-specific EHR, it will begin to see benefits immediately— both to patients and practice operations.
On the most basic level, timely access to patient information can significantly impact patient care and workflow efficiency. Real-time access to patient data from multiple locations and mobile devices gives physicians the information they need to respond to patient needs more quickly. With an EHR, gone are the days of wasted time hunting for paper records and trying to interpret handwritten notes. Now, physicians and staff can access current and historical information when and where they need it.
Combined drug, infusion, and Evaluation & Management (E&M) charges account for approximately 81% of a practice’s revenue.1 Missed charges and coding errors can dramatically affect a practice’s bottom line. Using an EHR system specifically designed to meet the unique workflow of oncology helps practices correctly capture all charges related to a patient visit and efficiently submit the charges to payers, reducing the risk of being underpaid and improving cash flow. In fact, one study that analyzed data from 75 physicians who used an oncology-specific EHR revealed that physicians realized an average increase in their E&M gross charge capture of 7.5% per patient visit after implementing the EHR. The gains were based on improved documentation leading to more accurate E&M coding. Obviously, this increase has a direct positive impact on the average gross revenue per physician.
Another sign of a successful implementation is a practice’s ability to demonstrate Meaningful Use and qualify for the maximum Medicare EHR incentives. According to a letter published in the February 21, 2013 issue of The New England Journal of Medicine, just over 12% of approximately 509,000 eligible professionals (EPs) said they met requirements for Meaningful Use incentives for EHRs as of May 2012. Reasons for such a small percentage likely include: (1) non-adoption of EHR technology; (2) use of EHR technology that isn’t certified to meet the standards; or (3) “unsuccessful” implementation of a certified EHR system, which could be a result of lack of efficient implementation, training, and support services. Remember that successful implementation of an EHR requires solid planning, training, and good support before, during, and after the install. As great as the technology may be, the people supporting it are often the real differentiating factor.
When selecting an EHR vendor, it’s critical to understand the vendor’s capability to help the practice meet the various stages of requirements for Meaningful Use. There were 25 Meaningful Use requirements in Stage 1. To qualify for payment, 20 had to be met. In 2014, EPs will begin meeting Stage 2, which requires reporting on additional objectives, meeting higher thresholds, and providing patients online access to their medical records through the use of patient portals. The purpose of these portals is to engage patients in their care, allow for easy access by patients to view and download their diagnosis and treatment information, as well as transmit information between physicians and patients via secure online messaging. Currently, several EHR vendors are struggling to help practices meet this requirement. Practices must be aware that as the requirements for Meaningful Use continue to ratchet up, so must each vendor’s capabilities.
Even EPs who did not qualify for the maximum incentive payouts under CMS’s program by demonstrating Meaningful Use of EHR technology in 2012 can qualify for incentives and avoid penalties that kick in by 2015 if they choose a vendor soon who can support them along the way. Additionally, with the use of oncology-specific technology, practices can minimize the negative effects of rising costs and declining reimbursement, and most importantly, capitalize on technology’s ability to improve patient care. As we forge ahead with advancements in technology, it’s exciting to see where we might go. Every day there are new innovations that allow us to re-imagine and improve upon our current healthcare information technology and its ability to enhance the quality and efficiency of cancer care. The key is for practices to implement technology that will help them meet their needs today and into the future.