Implementation of Electronic Chemotherapy Ordering: An Opportunity to Improve Evidence-Based Oncology Care

• Copyright © 2013 by American Society of Clinical Oncology

Implementation of Electronic Chemotherapy Ordering: An Opportunity to Improve Evidence-Based Oncology Care

1. Kerin B. Adelson, MD⇑, 
2. Ying Chun Qiu, 
3. Michelle Evangelista, MHSA,
4. Patricia Spencer-Cisek, MS, ANP, 
5. Clare Whipple, MD and
6. Randall F. Holcombe, MD

+Author Affiliations

1. The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY

1. Corresponding author: Kerin B. Adelson, MD, Assistant Professor, Tisch Cancer Institute, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1079, New York, NY 10029; e-mail: kerin.adelson@mssm.edu.

Abstract

Purpose: The degree to which electronic health records (EHRs) enhance the quality of patient care depends on use of the system to monitor and improve practice. In planning the transition to Epic’s Beacon electronic chemotherapy ordering platform, we saw an opportunity to measure our performance and increase evidence-based practice.

Methods: Advanced planning began 2 years before implementation and included formation of a chemotherapy council charged with reviewing references and approving each chemotherapy protocol; a readiness assessment; design of electronic flow-sheet adherent with Oncology Nursing Society guidelines. To monitor use of evidence-based treatments, we created a novel quality metric: the rate of evidence-based adherence (REBA).

Results: A full infusion schedule was maintained through implementation, with a transient 1-month increase in wait time. Our overall REBA of 0.86 significantly exceeded our prespecified goal of 0.80 (P = .001). REBA varied from 0.50 to 0.95 between disease groups. Antiemetic use increased by 20% after Beacon implementation. Provider satisfaction at 8 months ranged from 76% to 80%.

Conclusion: The transition to electronic chemotherapy ordering offers an institution the chance to develop evidence-based oncology practice, standardize supportive care, and enhance patient safety. The key elements that made our transition so successful were (1) extensive involvement of oncology leadership, (2) use of a chemotherapy council to enforce evidence-based practice, (3) ongoing collaboration between clinical operations and information technology. Finally, the REBA is a powerful tool to monitor adherence to evidence-based chemotherapy prescribing.