The Value of EHR Best Practices for Leading Oncology Networks

Gerard M. Nussbaum; Laura K. Rehfeld

April 2011, Vol 2, No 2 - Oncology


Arecent survey by Kurt Salmon of best practices among leading oncology networks in the country (www.kurtsalmon.com/oncology) suggests that the use of electronic health records (EHRs) in the most successful networks improves the flow of information between providers by using fewer, more robust systems with multiple access points, including EHRs, physician portals, and access through handheld devices.

The study included more than 132 inpatient oncology sites within regional oncology networks across the United States. It surveyed oncology leaders about current and planned levels of oncology network development. The participants (who requested confidentiality as a condition for participation) represent some of the largest and most respected oncology centers in the United States today.

The goal of the study was to provide oncology networks information about the level of EHRs and information technology (IT) in oncology practices. Questions included:

  • What are the current “best practices” in EHR and IT systems?
  • How do other oncology networks organize their IT resources and secure funding?
  • In what ways will the systems develop over the next 3 to 5 years?

Characteristics of Best Practices
Characteristics of leading oncology networks with EHR best practices include dedicated staff and increased dedication to developing EHR and common IT systems across network sites; for example, it is rare that these networks would have disparate registry software. Most have also implemented common systems within specific functional areas; for example, all radiation oncology is on one system and inpatient care is on another system (Table).

A key characteristic is their priority for developing a common EHR across all elements of oncology care, with IT goals and budgets that span multiple years. Although multiple IT systems will continue to exist, leading oncology networks bridge the gap with interfaces, health information exchange solutions, and physician portals.

Given the specialized needs of oncology, leading networks focus on an oncology-specific EHR that supports tight integration with clinical modalities. They recognize the immense opportunity of IT systems to link realtime clinical EHR with the longitudinal tumor registry to research clinical outcomes and protocol effectiveness.

To facilitate clinical information flow today, leading networks complement IT resources with a clinical coordinator who serves as the central point to ensure information is gathered, cataloged, entered into IT systems, and disseminated to members of the oncology care team. Clinical records are often received in various media. The clinical coordinator incorporates all these into the central EHR. Clinical coordinators also facilitate the sharing of updates and patient status with referring physicians, who may not have access to the central EHR.

Leading oncology networks expect the role of the clinical coordinator will continue to be essential well into the future, although their role will likely change.

They also have a stable funding model and budget to support centralized functions and network goals. This is accomplished in 1 of 2 ways: network sites contribute to a common budget or the system allocates funding to the network. The regular planning and budgeting cycle encourages the development of multiyear EHR initiatives, with some certainty that the goals can be achieved.

Oncology EHR Development
Despite the widely held belief that most oncology networks have robust EHR capabilities, this is not the case. Very few have achieved the desired level of IT sophistication; the vast majority continue to operate in a largely paper-based care universe. Given the predominance of paper-based manual systems, it is no surprise that oncology networks see expanding their EHR capabilities as a high priority.

Paul BrowneFor example, Paul Browne, Senior Vice President and CIO, Trinity Health, said, “Until there is a broadbased adoption of electronic health records, our ability to understand issues of quality, equity, and cost will be limited. Information technology is seen as critical to improving oncology patient care.”

Most oncology networks have a common vision to move to a single oncology EHR. One reason so few have adopted a single EHR to date is the limitations of current systems. No vendor has developed a comprehensive, mature oncology EHR platform that is fully integrated with an enterprise EHR, thus requiring networks to piece together different systems to support medical oncology, radiation oncology, inpatient care, and tumor registry functions.

In the rare cases where a single oncology EHR exists, it is usually achieved through niche solutions tied to treatment modalities and is only partially integrated with the hospital’s enterprise EHR. Throughout the study, networks expressed the goal of developing a unified oncology EHR among the sites, interfaced to the enterprise EHRs, and leveraging health information exchange to connect external providers.

Given the current and near-term future capabilities of enterprise EHR solutions, leading oncology networks will likely live in an interfaced world, electronically exchanging clinical information between general enterprise EHR solutions and specialized oncology EHR solutions.

Greater Value in Oncology Care
The majority of oncology networks have implemented some portion of the best practices. All networks express a desire to move toward a more complete set of systems and resources and common EHR solutions; however, many lack the funding and organizational cohesiveness to implement desired staffing models or IT solutions.

The main factors in the best practices for creating a common EHR include (1) a central guiding body comprised of network leadership and site clinicians that set the EHR plan and garner support from individual network sites; and (2) financial resources dedicated to oncology EHR.

Leading networks view implementation of an EHR as a requirement to advance clinical care coordination for demonstrating better outcomes, lowering cost, and increasing the value of care. As such, these networks create multiyear plans and budgets to support EHR development. We expect many networks to adopt this viewpoint over the next few years and invest in IT systems, interfaces, and health information exchange as a way to create growth and value in the future.