Abstract
296 Background: Patients’ treatment-related acute and late toxicities are essential clinical data, yet this information is widely dispersed among notes in the EHR. This lack of structure impedes clinician ability to efficiently and comprehensively integrate toxicity information into clinical management. We aimed to consolidate toxicity data to improve clinician efficiency in accessing this information, and to evaluate the utility of this tool in radiation oncology. Methods: We developed an auto-updating flowsheet view (“Synopsis”) in the Epic EHR that longitudinally integrates physician-graded CTCAE toxicity selected using a SmartForm embedded in EHR notes. Physicians timed themselves performing 4 tasks to assess acute and post-treatment toxicity information for patients seen in follow-up, alternating with vs. without use of Synopsis. Wilcoxon Rank-Sum testing compared recorded task times with and without Synopsis. A survey was sent to physicians regarding qualitative utility of Synopsis. Results: Six physicians reviewed 98 patients seen in follow-up (49 with Synopsis, 49 without Synopsis) at median 8.1 months (Synopsis) and 6.5 months (no Synopsis) since completion of radiation (p = 0.88). Use of Synopsis was associated with significantly faster assessment of: overall toxicity history (median 50 vs. 93 seconds, p = 0.0007), highest acute toxicity during treatment (median 19 vs. 40 seconds, p = 0.0002), highest post-treatment toxicity (11 vs. 65 seconds, p < 0.0001), and longitudinal review of a single symptom (8 vs. 61 seconds, p < 0.0001). Among 10 physician survey respondents, 100% reported that Synopsis improved efficiency and 30% reported it led to a change in management. All physicians felt it was important to understand a patient’s toxicity history, but 80% reported that time required with the note-based EHR structure was prohibitive; with use of Synopsis, 90% reported that this task was now feasible. Specific domains most improved included ability to: identify high-grade toxicities (100%), contextualize new symptoms (80%), summarize treatment-related toxicity (80%), navigate in the EHR to a time of high-grade toxicity (60%), evaluate the success of an intervention (30%), and decide whether to discuss a reported new symptom (30%). Conclusions: A centralized toxicity view in the EHR improves clinician efficiency in evaluating longitudinal toxicity data and enhances clinician ability to comprehensively integrate toxicity information into patient care.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call