Cost and time estimates for integrating a cardiovascular health application for cancer survivors in the electronic health record: Case studies from the NCORP network.

Abstract

e13557 Background: Clinical decision support (CDS) tools may support the delivery of guideline concordant cancer care yet must be integrated into EHR platforms and optimized for clinical workflow. Implementation outcomes are not well-documented in the literature for deployment of CDS tools in community oncology practices. Here we provide best practices for teams looking to implement CDS tools in diverse cancer care settings. Methods: The Automated Heart-Health Assessment (AH-HA-WF-1804CD) study is a clinic-randomized trial coordinated by the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base to support cardiovascular health assessment among cancer survivors. The AH-HA team developed and guided the implementation of the AH-HA tool, an EHR-based CDS visualization of the American Heart Association's Life's Simple 7 modifiable risk factors supplemented with cancer treatment information. Four NCORP clinics were randomized to the intervention arm and implemented the tool within their EHR leveraging Fast Healthcare Interoperable Resources (FHIR) standards and best practice advisories (BPAs). Information technology (IT) team authorization was required prior to randomization. We provided an implementation checklist to each clinic alongside virtual support from experts in implementing CDS for research and operational purposes. We describe our successful CDS tool implementation strategy and report the timeline for implementation at each clinic. Results: Although all clinics utilized the same EHR platform (Epic), clinics differed in terms of their time to approval, implementation, and tool activation, ranging in a total from 4 to 15 months. Although we provided step-by-step guidance for CDS deployment, each site required at least one technical assistance consultation. The estimated cost at each implementation site to deploy the tool, given a range of 40 to 80 hours at $150/hour, was $6,000 to $12,000 US dollars. Conclusions: Strengths of the implementation process included extensive documentation and clear communication of the steps for implementation. Clinics desired flexibility to adapt BPAs to their workflows. Site-level differences may pose challenges for interpretation of study implementation outcomes, including patient-level reach measures. Studies testing the impact of similar CDS tools should plan for clinic-level adaption and consider variability in timelines and assistance needed within the overall study timeline and budget. Clinical trial information: NCT03935282 .