Oncology electronic health records: More than just an e-secretary

Electronic health records can help oncology practices save money and work smarter. Then why has the adoption of e-technology been so frustratingly slow? A recent survey in the New England Journal of Medicine found that only 4% of physicians reported having a fully functional electronic health record (EHR) system; only 13% reported having a basic system (NEJM 359: 50-60, 2008).

Many docs worry about initial cash outlay, but in today’s tight fiscal environment, it makes bottom-line sense to transition from the paper to the electronic world. Health information technology (HIT) expert Robert S. Miller, MD, offers some advice on oncology EHR.

Oncology’s special needs

An EHR that supports an oncologist has to meet needs that are far more challenging than most medical disciplines. Some of the unique demands include accurate tumor staging, flow sheets, multidisciplinary workflow documentation, and integration of laboratory and imaging reporting.

Practices should begin the transition with a needs assessment to identify deficiencies, said Dr. Miller, who is based at the Sacramento Center for Hematology and Medical Oncology in Sacramento, California.

Most offices have a basic practice management system for billing, scheduling, and accounts receivable work, he noted.

“But when you transition to a clinical EHR system, you should know whether the system you’re buying has a built-in practice management system. If you intend to use your existing management system, make sure that the new EHR has a compatible interface. You certainly don’t want to have to duplicate your data,” he said.

The “Cadillac” of EHR

The next step is to determine systems capabilities. “The so-called Cadillac model is a computerized physician order entry system or a CPOE.

This is a point-of-care system that a provider uses to enter orders for chemotherapy, supportive care medications, and lab tests,” Dr. Miller explained.

A CPOE system will collect patient data, integrate this information with data from other sources, and guide the provider with clinical decision support in real-time care of a patient. “The CPOE model is what we all aspire to, but if your practice’s budget and workflow demands don’t warrant a fully operable CPOE, there are other options,” he advised.

An electronic prescribing system is one cost-conscious option. “There are free-standing systems or web-based programs, which are relatively inexpensive,” Dr. Miller said.

E-prescribing models also give clinical physician support that cross-checks patients’ medications for possible adverse drug interactions. Dr. Miller said that an inexpensive web-based e-prescribing system is an excellent way for physicians to “get their feet wet” before diving into a fully interoperable EHR model.

Enhancing patient care

“At ASCO, we’re actively trying to enhance EHR adoption. We have workshops to teach our members how to critically assess their needs and what to look for in a system,” according to Dr. Miller, who is on ASCO’s information technology committee.

As for the return on investment (ROI) in an EHR, Dr. Miller pointed out that some of the ROI benefits are “immediately tangible. You cut down on prescription costs, you save on record space, and you cut profit loss from waste. But a lot of the benefits are hard to measure, and this is one of the reasons for the low adoption rate.” As the U.S. government’s plan for HIT implementation gathers steam, the costs of EHR systems will come down, which should increase adoption rates.

“ASCO has promulgated a number of quality-of-care initiatives and we’re working with the vendor community to actually incorporate this material into their systems. Because after all, enhancing the delivery of patient care is the ultimate reason for EHR adoption,” Dr. Miller said.