Given the intricate nature of oncology workflow, terminology, cancer staging, and the high risk associated with chemotherapy administration, an oncology electronic medical record (EMR) system needs to be much more than a storehouse of patient information. According to David Henry, MD, Clinical Professor of Medicine, Pennsylvania Hospital, Philadelphia, and community oncologist, adopting these complex systems is well worth the initial costs and discomfort.
When did you first integrate an EMR system into your clinical practice?
Our seven-doctor hem/onc practice has been using an EMR system for about 6 years. Our first EMR was the iKnowMed Integrated Oncology Systems, and in 2010 we switched over to the MOSAIQ system.
Why did you switch systems after several years?
The iKnowMed was very good. However, the central reason for changing to MOSAIQ was the added functionality of data mining, which our first system didn’t do as well. To provide high-level care you need the ability to ask the system certain questions about how you’re treating patients. For instance, we’ll look at the last 100 patients with bone metastases and see if we treated them with bisphosphonates or denosumab (Xgeva).
Our current system allows us to see what we did in managing patients and how we could have improved our treatment of these patients. It is a very important functionality for driving better cancer care patterns.
We've heard varying reports on initial adoption of EMRs. What was your experience?
Most oncology EMRs on the market are fairly similar in certain core functionalities, but the amount of learning required depends on the specific practice dynamics. Our current system was clearly written by a computer genius without a doctor or nurse within a 20-mile radius. It is full of complicated computer jargon, which ultimately you learn, but at the beginning it’s like trying to speak a new language.
So the accepted wisdom—that EMR adoption is initially painful, but after 3 to 6 months that pain decreases—has been borne out by our experience. But the early learning curve associated with electronic medical systems is well worth it.
That said, you should anticipate a major disruption to your office practice. In fact, I would recommend that you cut the hour-per-day patient flow by 50% during the transition. You simply cannot operate as fast as you did prior to adoption. However, if you decide not to cut your volume, then you need to have one of the so-called fluent “superusers” at your elbow every day in the clinic for a few weeks to guide the transition.
Specific System Needs
Absolutely. Oncologists should be getting a totally oncology-specific system. Our system keeps excellent records of basic patient encounters, performs safe and crosschecked chemotherapy order writing, orders lab tests well, and of course compiles a database, so if I want to check to see whether a patient’s platelet count has changed over the past 6 months, I can just pull up the e-chart, and there are the data. Given the complex nature of cancer care, it is vital that practices adopt oncology-specific systems.
What are your system upgrade needs?
Naturally we are at the mercy of the vendor, who seems to roll out additions to the system in no particular order. The next function that’s going to be released is the e-prescribing module, which we really need. The system itself is modular, so the upgrades and add-ons are seamless, without any disruption to the practice.
Recommendations for Conversion
What suggestions would you give to a colleague who is readying to take the plunge into the EMR world?
The prospect is analogous to considering which smartphone to buy. All of them have different functionalities, and it depends on the personality of your particular practice as to which system best serves your needs. Naturally, smaller practices have different needs than larger, more complex organizations. So a lot of research is involved, but most important, when you get ready to transition to an EMR you must do a lot of critical self-evaluation about the true needs of your practice.
After the growing pains, does the EMR save time?
An EMR is not time-neutral. I finish my notes at 9:00 or 10:00 PM; there’s a tremendous amount of typing involved. However, we’re piloting a new voice recognition functionality that could significantly improve our time efficiencies. We’re adopting software called Dragon Naturally Speaking (see “Speeding Up the Patient Chart Process”), which is rolling out its 11th edition. We are currently in the testing stage, but so far we are very happy with its performance.
Any last thoughts about the place of electronic technologies in oncology?
Electronic health-care technologies are here to stay, for one thing, because these machines increase safety—not only in chemo ordering but also by giving the ability to treat patients from multiple sites. For example, this weekend I’m on call, so if a patient of one of my partners contacts me and says he doesn’t feel well, I can pull up all of the clinical information on that patient and make a timely and accurate treatment decision. Prior to EMRs, that wasn’t the case.
These technologies will continue to evolve and become an ever-more integral part of practicing medicine. ■
Disclosure: Dr. Henry reported no potential conflicts of interest.