Development of Electronic Medical Record Solutions for Immune Effector Cell Therapies: Single Institution Implementation in an Academic Medical Center

Abstract

Introduction/Objectives Immune effector cell (IEC) therapy is a novel treatment modality which can result in significant toxicities including cytokine release syndrome (CRS) and neurotoxicity. Consistent and thorough clinical monitoring is paramount to patient outcomes. Our goal was to create solutions in our electronic medical record (EMR), Epic®, to support our treating team in monitoring and providing treatment of these complex patients as well to aid in quality data monitoring that is essential for regulatory requirements. Methods Monitoring solutions created include a CARTOX10 nursing flowsheet (Figure 1), rounding synopsis (Figure 2), a CRS/neurotoxicity grading assessment tool (Figure 3), and two best practice advisories (BPA) (Figure 4). Results/Conclusion The CARTOX10 nursing flowsheet auto-calculates the patient's CARTOX10 score after the assessment is completed by the nurse [1]. The rounding synopsis is a data collection tool used by the treatment team to complete a review of toxicities and minimizes the amount of time it takes to navigate patients' charts. The grading assessment tool optimizes and standardizes provider documentation. It features drop-down menus for grading of CRS and neurotoxicity. Documentation with this tool includes discrete data elements that are easy to use and standardized focusing on the organs affected by CRS. The tool can efficiently be carried into the providers' daily progress note and tracks the patient's daily trends. Additionally, this documentation tool is helpful for data reporting purposes and quality monitoring. Our best practice advisories are used to notify providers to avoid corticosteroids outside the context of neurotoxicity or treatment resistant CRS as this has been proven to impact the effectiveness of IEC therapy.1 In the event that the patient presents acutely to the emergency department during the initial 4-week monitoring period, our second BPA notifies the emergency room staff to notify the treating team and to avoid the administration of corticosteroids. Lastly, our electronic orders include both admission and toxicity order sets. The admission order set features all supportive care and communication orders for staff to monitor patients. The toxicity order set mirrors our treatment algorithm and contains drop-down menus for each grade of toxicity with corresponding monitoring parameters.Utilization of these tools in our EMR has greatly streamlined our documentation, increased our treatment teams' ability to efficiently make critical treatment decisions in a timely manner as well as meet all data reporting regulatory requirements.