Compliance (COMP) with colon cancer (CoC) national guidelines (NG) for chemotherapy (CT) by implementing electronic medical records (EMR)

Abstract

17527 Background: Quality of care (QC) improves when NG are followed in patient (pt) management. Demonstration of COMP with NG is costly and slow (QOPI, and ASCO 2007 abstract 17050). We extended our prior experience to apply an EMR to monitor our pts for COMP with NCCN CoC CT guidelines. Methods: An EMR was implemented in 2003 in Wilshire Oncology Medical Group (6 CT sites and 8 medical oncologists (MO)). All pts seen in the offices were entered into the EMR by MO (ICD9 diagnosis (DX), stage (STG), history, orders) and staff (CT given). All pts were entered into a separate nonintegrated billing system (BIS) by staff. All pts with CoC seen between 6–1-06 and 5–31- 07 were evaluated electronically for DX, CT, and STG using EMR and checked in BIS. To study changes in COMP with NCCN NG for CT over time, 2 cohorts of pts were compared: pts initially seen prior to 6–1-07 (PRIOR); versus pts new after 6–1-07 (NEW). Results: Of 345 CoC pts seen by MO, 78 (25%) were seen in hospital only and not followed in office due to insurance, transfer of care, hospice, or no show. 33 (9.6%) had an incorrect ICD9 DX by MO or staff. Of 234 CoC pt in office, no STG was entered in 15 (6.4%, range per MO 0% to 13%). This was more frequent in PRIOR pt (8.9%) than NEW pt (2.3%, p=0.05). Pts were STG 0 2%, STG 1 12%, STG 2 22%, STG 3 21%, and STG 4 13%. CT was given to 0% STG 0, 3% STG 1, 24% STG 2, 29% STG 3 and 78% STG 4. CT improved by NG from PRIOR to NEW pt: STG 1 4% PRIOR to 0% NEW; STG 2 12% PRIOR to 44% NEW (p=0.02); STG 3 20% PRIOR to 52% NEW (p=0.008); but no change in STG 4 (81% to 75%, p=0.6). CT for STGs 2,3, or 4 increased from 28% to 53.6% (p=0.008), and varied by MO for NEW pt from 33% to 71%. Evaluation of reason for non-COMP with NG could not be evaluated electronically using this EMR due to lack of explanatory codes. Conclusions: EMRs can be used to monitor COMP with NG, track improvement over time, and evaluate variances in COMP between MO. MO completion of EMR data elements improves with time, but EMR data sets must be frequently monitored for completeness and accuracy by MO. EMRs should be integrated with BIS to avoid incorrect DX. Monitoring lack of 100% COMP with NG requires an additional explanatory code in EMR. QC can be improved by appropriate EMR use. This EMR has been updated after 6–07 to implement these conclusions. No significant financial relationships to disclose.