Capturing discrete complete staging elements in EPIC for new and progressing breast (B) and prostate (P) cancer patients: A quality training program pilot.

Abstract

117 Background: Staging is a fundamental quality metric. Entry of discrete elements of staging in the EHR supports & improves efficiencies for clinical notes, therapy summaries, survivorship plans, clinical decision making, pathway use, timely authorizations, clinical trial eligibility evaluations, as well as clinical, financial & quality outcomes. Staging of all new & progressing patients in our EPIC EHR was set as a priority in 2018 but baseline entry through 2018 was below target goals. Methods: A Staging QTP project group was formed & participated in the COH-ASCO QTP Fall training. Baseline capture of staging data in EPIC for campus and community (enterprise) sites for Breast (B) & Prostate (P) patients was collected. QTP processes were used to develop and implement a 12-week pilot with PDSA cycles at weeks 8 and 12. B & P cancer patients seen by 3 B & 2 P medical oncologists (MO), 5B surgeons (S) & 3P urologists (U) agreed to participate in a pilot study. Disease leads determined the elements of complete staging: 9-10 for B & 8 for P. Training was done for all campus APPs & for doctors in the pilot. Follow up by the QTP team was done at clinics during the pilot. Reports were built to capture specific staging elements for B & P patients by doctor. Reports were sent out starting week 9 indicating patients without complete staging with missing elements. A survey about the process was done by participant MDs & APPS weeks 8 & 12. Results: Baseline enterprise wide complete staging in Epic was 6% for B cancer & 3% for P cancer. 6 week PDSA showed capture of complete staging for B-MO & S was 20% and for P-MO & U was 12%. QTP Pilot ends 6/19 & abstract data will be updated for the staging & survey results. Additional results on complete staging for progressing patients is being captured. Conclusions: Complete staging in the EHR requires definition, training, resourcing, leadership support and feedback. Initial results show all new patients had initial staging data entered and complete staging rates increased significantly for new B & P cancer patients before weekly feedback was sent. Analysis of survey results will inform future PDSA cycles & plans for complete staging enterprise wide.