Implementing electronic health record–integrated screening of patient‐reported symptoms and supportive care needs in a comprehensive cancer center

Cancer ◽  
2019 ◽  
Vol 125 (22) ◽  
pp. 4059-4068 ◽  
Author(s):  
Sofia F. Garcia ◽  
Katy Wortman ◽  
David Cella ◽  
Lynne I. Wagner ◽  
Michael Bass ◽  
...  
Keyword(s):  
Supportive Care ◽  
Electronic Health Record ◽  
Supportive Care Needs ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Health Record ◽  
Care Needs ◽  
Patient Reported ◽  
Electronic Health ◽  
Integrated Screening

Abstract D046: Supportive care needs in diverse cancer patients treated at a Comprehensive Cancer Center

2020 ◽  
Author(s):  
Kelsey Shore ◽  
Kathryn E. Weaver ◽  
Karen M. Winkfield ◽  
Janet A. Tooze ◽  
Carla Strom ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Supportive Care Needs ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Needs

Teamwork and Electronic Health Record Implementation: A Case Study of Preserving Effective Communication and Mutual Trust in a Changing Environment

2016 ◽  
Vol 12 (11) ◽  
pp. 1075-1083 ◽  
Author(s):  
Anne H. Gross ◽  
Ryan K. Leib ◽  
Anne Tonachel ◽  
Richard Tonachel ◽  
Danielle M. Bowers ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Effective Communication ◽  
Similar Process ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Health Record ◽  
Mutual Trust ◽  
Team Members ◽  
Electronic Health

This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient’s trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR’s communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool’s functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.

Needs and Perspectives of Cancer Center Stakeholders for Access to Patient Values in the Electronic Health Record

2021 ◽  
pp. OP.20.00644 ◽  
Author(s):  
Anjali V. Desai ◽  
Rajiv Agarwal ◽  
Andrew S. Epstein ◽  
Gilad J. Kuperman ◽  
Chelsea L. Michael ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Patient Centered Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Health Record ◽  
Patient Centered ◽  
Centered Care ◽  
Electronic Health ◽  
Patient Values ◽  
Institutional Stakeholders

QUESTION ASKED: What is the most important information that diverse institutional stakeholders at a comprehensive cancer center need to know about patients to provide patient-centered care, and what is the best way to display this information in a new single-location feature in the electronic health record (EHR)? SUMMARY ANSWER: Thematic content analysis of semistructured interviews with a large and diverse group of institutional stakeholders at our comprehensive cancer center revealed themes informing design and development of the Patient Values Tab EHR feature, generated enthusiasm and buy-in for this digital innovation, created a sense of awareness among future users, and paved the way for implementation. WHAT WE DID: Qualitative data were collected through in-person, guide-based, audio-recorded, individual interviews with a total of 110 stakeholders representing a wide range of disciplines and professions, as well as others involved in administration of the hospital or clinics within our cancer center. WHAT WE FOUND: Respondents felt that to facilitate the delivery of patient-centered care, information in the following categories should be displayed: the patient's personhood, support system and resources, social history, communication preferences, future planning, end of life, and illness and treatment understanding. Other important themes that arose in the interviews included implementation considerations, improved communication and relationship building, and privacy implications. BIAS, CONFOUNDING FACTORS, DRAWBACKS, REAL-LIFE IMPLICATIONS: Since this study was conducted at a single dedicated cancer center, generalizability of findings across other healthcare settings merits further investigation. It is possible that non–English-speaking clinicians and patients, who were not interviewed, might have different needs or perspectives. We designed our Patient Values Tab for our institution's EHR (Allscripts); however, this display feature can be configured in other EHR software. By interviewing a large and varying sample of stakeholders and rigorously analyzing their responses, we obtained robust results to inform the development and implementation of this innovative EHR feature centralizing key information needed to enhance patient-centered cancer care. The introduction of the new Patient Values Tab at this well-known cancer center signals the importance of patient personhood and values throughout the institution and advances the use of the EHR as a driver of the delivery of patient-centered care throughout the illness.

What does social isolation have to do with my arthritis? Patient and provider views of the implementation of an electronic Social Determinants of Health risk assessment tool

2020 ◽  
Vol 64 (1) ◽  
pp. 707-710
Keyword(s):  
Electronic Health Record ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Assessment Tool ◽  
Determinants Of Health ◽  
Health Record ◽  
Institute Of Medicine ◽  
Patient Reported ◽  
Item Responses ◽  
Electronic Health

Social Determinants of Health (SDoH) are the conditions in which people are born, live, learn, work, and play that can affect health, functioning, and quality-of-life outcomes. The Institute of Medicine charged healthcare institutions with capturing and measuring patient SDoH risk factors through the electronic health record. Following the implementation of a social determinants of health electronic module across a major health institution, the response to institutional implementation was evaluated. To assess the response, a multidisciplinary team interviewed patients and providers, mapped the workflow, and performed simulated tests to trace the flow of SDoH data from survey item responses to visualization in EHR output for clinicians. Major results of this investigation were: 1) the lack of patient consensus about value of collecting SDOH data, and 2) the disjointed view of patient reported SDoH risks across patients, providers, and the electronic health record due to the way data was collected and visualized.

scholarly journals Care-paradigm shift promoting smoking cessation treatment among cancer center patients via a low-burden strategy, Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment

2019 ◽  
Author(s):  
Alex T Ramsey ◽  
Ami Chiu ◽  
Timothy Baker ◽  
Nina Smock ◽  
Jingling Chen ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Electronic Health Record ◽  
Paradigm Shift ◽  
Point Of Care ◽  
Cancer Center ◽  
Evidence Based ◽  
Health Record ◽  
Smoking Cessation Treatment ◽  
Cessation Treatment ◽  
Electronic Health

Abstract Tobacco smoking is an important risk factor for cancer incidence, an effect modifier for cancer treatment, and a negative prognostic factor for disease outcomes. Inadequate implementation of evidence-based smoking cessation treatment in cancer centers, a consequence of numerous patient-, provider-, and system-level barriers, contributes to tobacco-related morbidity and mortality. This study provides data for a paradigm shift from a frequently used specialist referral model to a point-of-care treatment model for tobacco use assessment and cessation treatment for outpatients at a large cancer center. The point-of-care model is enabled by a low-burden strategy, the Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment program, which was implemented in the cancer center clinics on June 2, 2018. Five-month pre- and post-implementation data from the electronic health record (EHR) were analyzed. The percentage of cancer patients assessed for tobacco use significantly increased from 48% to 90% (z = 126.57, p < .001), the percentage of smokers referred for cessation counseling increased from 0.72% to 1.91% (z = 3.81, p < .001), and the percentage of smokers with cessation medication significantly increased from 3% to 17% (z = 17.20, p < .001). EHR functionalities may significantly address barriers to point-of-care treatment delivery, improving its consistent implementation and thereby increasing access to and quality of smoking cessation care for cancer center patients.

scholarly journals Frequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory Care Notes

2020 ◽  
Vol 3 (6) ◽  
pp. e205867 ◽  
Author(s):  
Sigall K. Bell ◽  
Tom Delbanco ◽  
Joann G. Elmore ◽  
Patricia S. Fitzgerald ◽  
Alan Fossa ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Ambulatory Care ◽  
Health Record ◽  
Patient Reported ◽  
Electronic Health

The role of electronic records in reporting adverse drug reactions.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 309-309
Author(s):  
Alanna M. Poirier ◽  
Paul Nachowicz ◽  
Subhasis Misra
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Electronic Health Record ◽  
Adverse Drug Reactions ◽  
Improve Patient Safety ◽  
Cancer Center ◽  
Health Record ◽  
Drug Reactions ◽  
History Of ◽  
Electronic Health

309 Background: The Pharmacy and Therapeutics committee at a regional cancer center is responsible to report and trend existing adverse drug reactions. The electronic health record did not have an option to document the history of an event or have an alert function if a medication was re-ordered. The frequency of documented adverse drug reactions did not correlate to what was being observed on the units with the use of a paper document. Methods: InAugust 2010 a Lean Six Sigma project was initiated to improve adverse drug reaction reporting. An adverse drug reaction document along with standard work instructions was completed by March 2011. A report was built in the electronic health record and a computer based learning module was created and rolled out to clinical staff by October 2011. Results: The turn-around time in days to document an adverse drug reaction in the patients chart decreased from 6.8 days to 0.7 days. The documented adverse drug reactions increased by 37%; verified by the use of supportive medications. Conclusions: The root cause for under-reporting was attributed to lack of knowledge, process, and automation. The history of an adverse drug reaction can now be viewed and an automatic alert is produced requiring physician acknowledgement decreasing the chance of repeated discomfort or harm to the patient. Adverse drug reaction documentation can be retrieved within 24 hours, analyzed, trended, and used for educational purposes to improve patient safety. [Table: see text]

Implementation of a distress/supportive care screening tool in lung and head and neck cancer clinic.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21646-e21646
Author(s):  
Mary Pasquinelli ◽  
Sandra Obilade ◽  
David Rosenberg ◽  
Zane Deliu ◽  
Aakash Shah ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Screening Tool ◽  
Supportive Care Needs ◽  
Cancer Center ◽  
Head Neck Cancer ◽  
Cancer Type ◽  
Care Needs ◽  
Head Neck

e21646 Background: Identifying and addressing depression, anxiety, and supportive care needs in cancer patients is an emerging standard of care. The Coleman Foundation “Patient Screening Questions for Supportive Care” tool was used with demographic and diagnostic data to investigate the relationships between screening scores. Methods: Lung/head/neck cancer patients at the University of Illinois Cancer Center were screened using the Coleman Foundation tool. This screening tool identified needs in several categories including Patient Health Questionnaire 4 (PHQ-4) scores; practical, family/caregiver, nutritional, treatment, physical, and spiritual/faith/religious concerns; levels of pain, fatigue, physical activity to quantitatively assess patient distress/supportive care needs. Scores were compared with age, sex, race/ethnicity, insurance, cancer type, and cancer stage. Linear regression was used for statistical analysis. Results: We performed initial screening on 164 lung/head/neck patients ages 36-88 (mean 61), with stages IA to IVC (May 2016 to Jan. 2017). Our findings are summarized in below. We found a 1oeffect that racial/ethnic minority status was significantly correlated with higher scores. We found that lung cancer was correlated with higher screening scores than head & neck on initial screen. Medicare insurance was correlated with significantly lower screening scores. Conclusions: Patients with lung/head/neck cancer have significant needs and concerns that go beyond merely treating their cancer. Our findings show that certain demographic groups have especially high burdens in some specific dimensions and that these specific concerns may be predicted based on diagnostic and demographic information. Thus, these findings serve to inform providers as to where and how to focus supportive care for these patient populations. [Table: see text]

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