Impact of EHRs on Oncology Practice: Enhancing the Value of Cancer Care
By Gena Cook
Chief Executive Officer and Cofounder of Navigating Cancer
Widespread adoption of information technology (IT) is now regarded as a pathway to improving healthcare and achieving the highly regarded goals for redesigning care. Achieving these goals will require new approaches to health system design, including continuous improvement of relationships between physicians and patients and tools that help providers have the right information at their fingertips to provide the best care to patients and tools for patients to actively participate in their own care.
The Health Information Technology for Economic and Clinical Health (HITECH) Act provides new incentives for providers to digitize their practice. The act peaks in 2012 and starts to penalize providers starting in 2015 and beyond, if they have not met the various stages of meaningful use objectives. To qualify for the incentives, providers must incorporate certified electronic health record (EHR) technology into their practices.
Where Are We Today?
As a result of the HITECH incentives, most providers are initiating plans to qualify for the stimulus payments, but few are ready. It is estimated that of the 12,000 US oncologists, only approximately 25% (an estimate based on oncology-specific EHR vendor- reported install base divided by the number of US oncologists) have either implemented or signed up for an EHR. But only the oncologists who are on a web-based platform are on a HITECH-certified version today.
Client server applications, which are the leading oncology-specific EHRs implemented in the marketplace today, are starting to schedule their first upgrades this summer. It will take time to upgrade their entire customer base, and providers cannot certify for HITECH incentives until they have upgraded to the certified version of their HER system. In April 2011, some oncologists received their first stimulus payments.
Because providers will not be penalized for waiting until 2012, many oncology practices plan to certify in 2012 to receive the maximum payments. We are therefore seeing many practices buy and adopt EHRs, plan upgrades to the certified version if necessary, and start implementing patient portals so they can meet the patient objectives.
In the next few years, the focus will be on adopting the right technology, and then working within the practice to meet the meaningful use objectives, which will continue to increase. In 2014, stage 2 criteria will need to be met, and in subsequent years, stage 3 criteria will be announced.
Interoperability between information technologies will be a priority to minimize duplicate entry and work within the practice. As this evolves, the ability to implement new IT products and features to reduce duplication of efforts will become necessary to continue to improve the cancer care paradigm.
Sharing Best Practices
Throughout this process, providers still need to do their complex day job, which involves taking care of patients in a broken and inefficient healthcare system. To implement these changes effectively will require commitment and participation from every staff member, because many jobs will be adjusted with the use of IT.
Provider groups, state societies, and other support organizations should support providers in the effort to share best practices and work with the IT vendors to make changes that are not only necessary to meet meaningful use objectives but also to help practices do their jobs with as few keystrokes as possible.
Patients today have little to no access to their healthcare data and to the information needed to participate in their care. Although 86% of patients go online to look for healthcare information, 1 they still have difficulty finding the information that is pertinent to their specific condition, which is especially problematic for patients with cancer.
With HITECH, patients have the most to gain, because providerswill be required to give them access to their health information, information “prescriptions,” which include personalized disease-specific education and eventually securemessaging and other self-management tools to participate in their own care.
The Transformed Healthcare System of Tomorrow
With widespread adoption of information systems and interoperability within systems, it is conceivable that the healthcare system can be transformed. Providers and patients can envision a system that can produce better outcomes, higher quality, and lower costs than today.
With IT, providers can minimize waste and duplication and provide transparency to patients and to other providers. Today, patients are transported through the healthcare system from appointment to appointment but have very little transparency to the process. Other than showing up at their appointment and adhering to their prescribed medications (which many patients do not do), little is required of a patient.
In tomorrow’s system, patients will have the ability to see parts of their healthcare record, understand their laboratory values in a longitudinal way, and receive more information about their health to minimize disease and actively manage it when diagnosed with cancer or other illnesses. Patients will be able to use technology, and most likely be required to manage the transactions of their care online, such as requesting prescriptions, appointments, and laboratory testing.
IT and Personalized Medicine
Oncology providers, because of the growing complexity of cancer care in the era of targeted therapies, will have the right data to provide personalized care to each patient. Providers will be able to easily view tests, laboratory results, and care that patients have already received to avoid duplication and make better decisions.
Oncologists will have decision support tools to help guide their decisionmaking as cancer becomes more complex and personalized, as well as tracking tools to eventually understand the outcomes of the various options in clinic.
Because patients will have access to their own health information, providers will be able to give patients better instructions to manage and facilitate better communication between face-to-face appointments. Providers will be able to log in to their information systems to monitor patient medication adherence and side effects and provide interventions as needed throughout the care process, not just in the 15-minute time slots with patients today. This enhanced communication will help patients understand the meaning of their data and foster better postvisit adherence to medical instructions.
Medical staff will enjoy the efficiencies of IT as well. Phone calls, fax machines, and clipboards of information will become obsolete, because online tools will make the process more effective for all. We are seeing those changes in the airline industry today, where we check in online within 24 hours of a flight or through a kiosk at the airport. Today, we are already starting to see this applied to medical practices in small ways as practices and clinics implement kiosks and patient portals and create interoperability between their current and new information systems.
Where Do We Go from here?
A lot will be required to get to the desired state. This transformation will take time, and we are at a critical juncture within the healthcare system and in cancer care. Healthcare is now on the national agenda, and HITECH provides incentives for providers to digitize their practices before beginning to penalize those not compliant by 2015 and beyond.
Providers not meeting the objectives by then will see decreases in their Medicare fee schedule. Accountable care organizations and medical homes will require digitization to meet the requirements and establish new relationships with patients, with unique implications for cancer care. New payment models in oncology are being piloted today, including technology systems, with hopes of establishing new models that better align the healthcare system to improve the quality and increased cost-effectiveness of cancer care.
IT is a component of all these changes, and the time is now for oncologists to become vigilant about improving efficiencies and reducing the waste that exists with inefficient processes and systems. These investments have steadily been made over the past 10 years by thousands of oncologists, but interoperability between systems and broken processes still continue to cause more administrative burden than necessary.
Oncology practices need to continue on this path, sharing best practices with each other, and steadily improve leveraging information systems whenever possible to provide the highestquality cancer care for their patients
Fox S. Looking for health information is the third most popular online activity measured in our surveys. Health Topics. PewInternet. February 1, 2011. www.pewinternet.org/Reports/2011/HealthTopics/S ummary-of-Findings/Looking-for-health-information. aspx.
Accessed August 1, 2011.