Implementation of electronic chemotherapy ordering: An opportunity to improve evidence-based oncology care.

Abstract

323 Background: On April 20, 2012, Mount Sinai Medical Center was the 63rd site to go-live with the Beacon chemotherapy module of the EPIC EMR. EPIC support reports that ours was one of the most successful launches to date. Previously, all our chemotherapy orders were handwritten with variable adherence to evidence-based chemotherapy and supportive care guidelines. Our goals were 1) reduce errors and improve patient safety, 2) increase use of evidence-based treatment, 3) optimize supportive care and 4) improve practice efficiency. Methods: Fourteen months prior to the go-live we formed a Chemotherapy Council, made up of Oncology physician, nursing and pharmacy leadership and a Beacon-trained Build Team, including an oncology nurse and two chemotherapy pharmacists. Individual disease groups submitted lists of their regimens with references, which were used to create paper orders. The council met weekly to review the orders, references, nursing communications, and NCCN treatment, antiemetic and supportive care guidelines. Once approved, these paper orders served as templates for more than 400 electronic protocols. Each protocol was validated by a utilizing physician. Results: 98% of patients had electronic orders entered prior to go-live (394 chemotherapy and 116 supportive). There were no patient safety issues during the go-live period. In a survey one-month post go-live, 72% of users felt that Beacon had improved their day-to-day efficiency and 72% of users felt that the quality of patient care had improved. Conclusions: The transition to electronic chemotherapy ordering offers an institution the chance to develop evidence-based oncology practice, standardize supportive care and enhance patient safety. It is essential to develop procedures to avoid electronically immortalizing unproven regimens or chemotherapy dosing errors. The key elements that made our Beacon transition so successful were: 1) extensive involvement of oncology leadership, 2) use of a chemotherapy council to enforce evidence-based practice, 3) clinician validation of every protocol and 4) ongoing collaboration between clinical operations and IT regarding the impact of electronic ordering on downstream operations.