The Truth About Electronic Health Records

It’s hardly shocking that physicians have generally resisted moving over to electronic health records (EHRs). Cost concerns and well-founded wariness over the lack of standards-based interoperability among many EHR systems has prevented many a doctor from making the leap.¹

The problem is that healthcare information technology isn’t going away. In fact, much like an aggressive disease, it’s only going to grow stronger. Health reform and its ever-evolving changes are quickly transforming the EHR conversation from one of “I’ll stick with paper” to “I’d best do this if I want my practice to be fully efficient.”

The value gained from carefully researching and employing an EHR system is worth the investment, especially for oncologists, who are managing a gravely sick patient population.

The US Oncology Network is one of many oncology-based organizations that advocate for the use of healthcare information technology, encouraging physicians to embrace the array of benefits that lead to fewer errors, better targeted care and improved outcomes, access to vital life-saving treatments, and the latest research.²

Pick and Choose

The Oncology Electronic Health Record Field Guide,³ a publication of the American Society of Clinical Oncology (ASCO), encourages oncologists to adopt an oncologyspecific EHR rather than a generic one. For economic reasons, however, some oncology practices have opted for generic EHRs that have been tailored to their needs. But going this route carries the risk of not having the full menu of critical features that oncologists need. Plus, it’s still likely that even oncology-specific EHRs will need to be customized within the subspecialties. For example, surgeons may not have much use for an EHR with a prescription-writing function because they typically prescribe only a handful of formulary medications for a limited amount of time, as opposed to medical oncologists whose chronically ill patients need multiple drugs. Each oncologist should pick and choose the functionalities they need, as laid out by ASCO:

• Tumor staging—Tumor-Node-Metastases (TNM) nomenclature and others

• Multidisciplinary and data-intensive work flow—pathology, lab, imaging

• Chemotherapy dosing and administration

• Toxicity assessment and management

• Clinical trial and protocol management

• Drug inventory management

• Survivorship care

Yet another benefit to employing an EHR is the fact that payers are giving closer attention to pay for performance (P4P). Knowing this, oncologists should be further encouraged to adopt the technology to ensure the efficient incorporation of consensus measures of quality and the use of best practice tools.

Add a Portal

Some EHRs include a patient portal application, enabling the physician to gather a patient’s medical history before the first visit. With the portal, an individual’s medical data can be directly uploaded into the EHR and become part of the permanent record.³

Additionally, with some systems, patients can establish and manage a separate personal health record (PHR), either as part of the EHR or as a separate Webbased tool. PHRs can store treatment history, making it simple for other medical facilities to capture and use the information.³

From a physician-to-physician standpoint, The US Oncology Network offers a Web-based community called “The Oncology Portal,” which allows its member physicians to collaborate in real time.³

Case Study: Patient Portal

The following summary is from Navigating Cancer, Inc, an oncology-specific, HITECH- certified patient portal⁴:

Hematology Oncology Consultants, PA, is an established practice with 6 oncologists and 2 locations in the Orlando, Florida, region. They had not yet adopted an EHR and were looking for a solution that could help them achieve 3 goals:

• Offer their patients electronic access to their medical records and solve additional criteria to help them qualify for the federal HITECH Act Meaningful Use incentives.

• Begin capturing patient information in a structured database that had the flexibility to integrate with any future EHR vendor they selected.

• Find a cost-effective solution that would improve their new patient registration process while providing them with hard cost savings.

After implementing the patient engagement portal, the practice realized the following results:

• New patients register online from home, where they have access to their medical history, resulting in more complete and legible forms.

• Patient information now captured in a structured database, and once integrated with an EHR, will provide patients with access to their medical records online, both requirements to qualify for the Meaningful Use incentives.

• Patient education materials now delivered electronically, another requirement to qualify for the Meaningful Use incentives. Eliminated the need for paper materials, freeing up storage space in the clinic.

• Eliminated hard costs for printing and mailing new patient registration materials, saving $100 per doctor per month.

• High patient satisfaction, with 90% of patients agreeing or strongly agreeing that the online registration process was better than filling out paper forms.

Connect With Other Healthcare Organizations

Oncology reimbursement is changing as health reform continues to take shape. Bundled payments, episode-of-care payments, and, potentially, full capitation,

are in the offing. To meet federal meaningful- use incentive targets, satisfy the data demands of health plan P4Ps, and participate in accountable care organizations (ACOs), it’s important for oncologists to collaborate with other providers, hospitals, and insurers so that no one loses momentum during the transition.⁷

To expedite the process, oncologists should choose an EHR that’s interoperable with other EHRs in their network. Talk to peers, physician referrers, and nearby hospitals to find out which EHRs they use. Also make sure that the EHR has interfaces to connect with those systems. If they don’t, contact the vendor to find out how much the development costs will be. Connectivity between EHRs is the future and should be considered when deciding which one to choose.⁵

Arm Yourself With Expert EHR Knowledge

The Oncology EHR Field Guide: Selecting and Implementing an EHR is a comprehensive, oncology-specific handbook developed to help practitioners select and implement current and future EHRs. Developed with input from volunteer oncologists, the 64-page book costs $76 for members and $95 for non-members. The following chapters are included:

• The Core Functions of an Oncology EHR

• Identifying the EHR Team and Beginning the Planning Process

• Building the Budget

• Making the EHR Selection

• Implementing the EHR

• Making the EHR Work for You

• Using the EHR to Support Quality of Care and Patient Safety

• Post-Implementation Ongoing Management

Source: Reference 6.Funding Source: None

Author Disclosure: The author (CS) reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.1. Miller RS. Electronic health record certification in oncology: role of the certification commission for health information technology. JOP. 2011;7(4) 209-213.

2. The US Oncology Network. Advancing cancer care: deploy healthcare IT. http://www.usoncology.com/cancercareadvocates/AdvancingCancerCare/DeployHealthcareIT. Accessed November 22, 2011.

3. The American Society of Clinical Oncologists. The Oncology Electronic Health Record Field Guide. http://www.asco.org/ASCOv2/Department%20Conten/Cancer%20Policy%20and%20Clinical%20Affairs/Downloads/EHR/EHRFieldGuideSamplePages.pdf. Accessed November 22, 2011.

4. Medscape: the right EHR for an oncology practice. http://www.medscape.com/viewarticle/740539. Published April 2011. Accessed November 22, 2011.

5. Navigating Cancer, Inc. http://www.navigatingcancer.com/blog/oncology-patient-portalcase-study/. Published July 13, 2011. Accessed November 22, 2011.

6. Oncology Electronic Health Record Field Guide (content and pricing information). American Society of Clinical Oncology Web site. http://www.asco.org/ASCOv2/Practice+%26+Guidelines/Practice+Management+%26+Reimbursement/Electronic+Health+Records+%28EHR%29/Help+with+EHR+Selection%2C+Installation%2C+and+Adoption/EHR+Field+Guide.