Due to a variety of factors, today’s oncologists face multiple challenges in collecting, managing, and sharing their patients’ health data.
Istvan Pataki, MD
Due to a variety of factors, today’s oncologists face multiple challenges in collecting, managing, and sharing their patients’ health data. One challenge involves the sheer volume of information that is typically generated in routine oncology care. This includes an increasing number of diagnostic, prognostic, and monitoring tests that physicians administer to plan, monitor, and adapt treatment to optimize safety and efficacy. Additionally, the growing use of multimodal therapy creates an increasingly complex treatment environment that may involve care providers across multiple disciplines and departments, such as medical oncology, radiation oncology, and surgery. Moreover, many patients may receive supportive care, such as nutrition counseling and mental health services, which must also be incorporated into their medical records.
The data deluge does not end when the patient completes treatment. Patients with cancer typically face years of follow-up care, which can be as frequent as every few months in the years immediately following treatment. For patients with relapsed cancer, accurate recording of prior therapy is essential for guiding additional treatment planning, because response to earlier therapy can be prognostic for the potential efficacy of second- or third-line treatment. Additionally, use of certain cancer agents may contraindicate patients for repeat use of those drugs or other therapies. Finally, with a growing emphasis on learning from each patient’s experience, many care providers and institutions also collect outcomes data that can be used to understand the interactions among demographic, diagnostic, and prognostic factors and how they influence response to different therapies.
Although the amount of patient data itself can be overwhelming, the challenge to effective and efficient data collection is exacerbated when the data collection platforms vary among departments or facilities and applications, such as the devices used to plan and deliver radiation therapy. The collection and sharing of data between institutions is still largely manual and paper based. This typically means that test results, patient histories, and information about prior or concurrent treatment performed outside a provider’s institution must be collected via fax and scanned before being added to the patient’s electronic health record (EHR) as a PDF file. Finally, physicians must also navigate an increasingly complex regulatory landscape related to the collection, retention, and security of patient data.
As a result of these factors, oncologists are spending an increasingly large percentage of their time managing patient data and generating documentation to complete a comprehensive treatment record. This leaves them less time to spend with patients and can also result in burnout. The growing demands of collecting and managing patient data increase the need for additional administrative staff to support patient data management, which can increase costs for care centers and providers.Fortunately, a growing number of electronic and software solutions help mitigate the challenges of patient data overload. New EHR platforms can seamlessly integrate data from multiple sources, such as treatment planning software, treatment delivery devices, scheduling, and billing. Moreover, healthcare information technology innovators are capitalizing on advances in automation and artificial intelligence to reduce the amount of manual effort needed to capture, enter, and share patient data. Such advances include voice recognition technology that enables automated, real-time dictation and facilitates data sharing and follow-up actions.Cape Fear Valley Cancer Center is one of the largest cancer facilities in North Carolina. The institution is committed to improving the quality of life of all its patients, and the cancer care providers strive to achieve this goal through a patient-centered approach that emphasizes innovation, teamwork, and accountability. Until recently, its ability to realize this vision was hindered by a slow and expensive approach to EHR data entry, which entailed a cumbersome, multistep process that comprised dictation, transcription, and editing. Completing an entry took up to a week, making it difficult to achieve real-time tracking of patients who might have multiple appointments, tests, or procedures within that time frame. This slow and inefficient process was also very costly, requiring 3.5 fulltime transcriptionists and an outside agency to support 14 providers. Moreover, the effort to generate accurate and timely patient notes reduced the time physicians had available for patient care, creating time and cost inefficiencies for the cancer center’s staff and leading to physician burnout.
Recognizing that this approach to oncology patient data management was neither optimal nor sustainable, the cancer center sought transformative technologies that would increase efficiencies, reduce cost, and allow oncologists to spend more time engaged with their patients and less time bogged down in note-taking. After evaluating several options, the cancer center implemented a cutting-edge speech-to-text technology solution, Palabra, that works with the center’s EHR, MOSAIQ Oncology Information System. MOSAIQ enables efficient management across radiation and medical oncology programs because it uses a common database for radiation and chemotherapy records. This provides a single point of access for patient data, which is especially critical for the many patients who receive multimodal therapy. It simplifies the management of complex treatment regimens with automated and customizable workflows while facilitating personalized treatments through decision support that enables more informed clinical decision making. The use of automation to pull data from treatment planning and delivery systems reduces errors and patient wait time by eliminating data entry errors and unnecessary procedures.
Palabra is a clinical documentation system that integrates speech recognition engines, such as Dragon Medical and M*Modal, deep into MOSAIQ and includes sophisticated voice-driven dictation for ease and efficiency. Palabra fully automates the document creation process and reduces physician workload through a powerful combination of voice, automation, and highly personalized templates. Because of its deep integration with MOSAIQ, Palabra enters data into the EHR in real time without the need to review transcripts later. Physicians can make changes or adjustments using voice commands before approving the note at the end of the patient’s visit. This has created tremendous time savings of 30 to 60 minutes per day, which physicians can now devote to patient care. Palabra also allows the document to be transferred to the referring physician upon approval. This capability enables providers to create comprehensive and accurate patient notes instantly compared with the 5 to 7 business days required for the legacy process. Additionally, the ability to use voice-enabled dictation has eliminated more than $200,000 in annual transcription costs for the cancer center—further streamlining documentation for the entire patient population, which includes approximately 2000 new hematology and oncology patients and 1500 analytic cancer cases every year.
The use of Palabra Favorites also simplifies the dictation process and reduces the pitfalls that the center experienced using Dragon alone by enabling improved accuracy and profile management, especially with respect to medical terminology, which may not be recognized by other voice-recognition applications. Another key feature that attracted the cancer center to Palabra is its use of individualized templates that allow physicians to merge fields and import data according to their preferences while maintaining the cancer center’s standards. This includes automated entry of discrete data sets, such as for Centers for Medicare & Medicaid value-based program reporting into MOSAIQ, without any human intervention. This is a very powerful functionality, because all the data for orders, charges, schedules, quality checklists, and assessments populate within MOSAIQ as soon as the note is approved. It’s also important to mention that these notes are also readily available through the cancer center’s information system to help improve visibility into the patient’s treatment. This helps eliminate information silos that interfere with effective data sharing among multiple care team members and facilitates collaborative decision making based on a shared understanding of the patient’s history, current status, and treatment goals.Today’s oncology care ecosystem is complex, and streamlining the processes for patient data collection and management is essential for providing optimized, timely, and cost-effective care. Based on the Cape Fear Valley Cancer Center experience, other cancer care centers seeking new data management approaches should work to identify platforms that offer maximum flexibility with respect to interoperability and data sharing. Automated solutions that seamlessly integrate treatment planning, treatment delivery, scheduling, and document management are also recommended, because these platforms can reduce the time and errors associated with manual data entry. Care centers must ensure that any new system will be compliant with the increasingly stringent requirements for patient data collection, retention, and security. Additionally, any new technology solution for the challenges of oncology patient data management should allow effective communication among caregivers— within a single institution and with external providers.
Finally, it is important to ensure that any system or solution adopted today is future-proof. Just as oncology care evolves to incorporate new understandings and therapies, healthcare information technology is highly dynamic. Any system adopted today should have the flexibility to evolve over time, ensuring that cancer care centers can continue to offer patients the best care possible.
The authors and Cape Fear Valley Cancer Center have no financial interest in Palabra or Elekta, developer of MOSAIQ, or in the success of any of these companies’ products, nor have they received any promotional or other fees associated with writing this article.