Improving routine use of clinical pathway decision support through EMR integration.

Abstract

432 Background: There has been an explosive growth in oncology with an evolution of precision oncology based on molecular profiling. Providing evidence-based, high quality, equitable care is a foundational mission for Kaiser Permanente (KP). Thus, KP created a systematic approach toward oncology care pathways that incorporated organizational leadership, structured participation and feedback, novel integration of clinical decision support (CDS) tools, and evaluation of efficacy, safety, and value. Our goal was to make it easy and preferable for physicians to access clinical decision support for every patient, every time. Methods: KP’s inter-regional oncology chiefs, supported by relevant teams in evidence analysis, pharmacy, and other clinical specialties, convened monthly meetings in 10 oncology sub-specialties to synthesize evidence and create care pathways for priority conditions. The pathways are published to KP’s Clinical Library (CL), a trusted, curated resource of clinical knowledge guidance and tools, available via KP’s Epic Systems electronic medical record (EMR). The pathways are represented as intuitive, graphical, clickable process diagrams, with additional clinical content available as hover text. CL uses standard Epic interfaces to receive contextual information when accessed from a patient encounter. When the physician browses the CL oncology pathway and selects a treatment recommendation, CL returns to the EMR with the specific treatment plan queued up for ordering. We began initial deployment of these inter-regional pathways in Feb 2020. We combined EMR data with CL data to understand the impact of this clinical decision support. Results: We experienced dramatic uptake of oncology clinical pathways despite offering minimal training and no external incentives. KP orders over Beacon treatment plans annually in the clinical conditions supported by our pathways. In the first quarter of deployment, clinicians ordered 9% of these protocols through clicking on CDS in CL. Over the course of 2 years, we saw pathway-based ordering grow to over 75% of eligible patients. Conclusions: We find that we have made considerable progress toward our goal of having physician users consult clinical pathways decision support before ordering oncology drug treatment protocols. As with all clinical guidance, we would not expect 100% of patients to follow the recommendation, due to clinical variation and co-morbidity, but we find that by making clinical pathways easily accessible and actionable within normal clinical workflow, physicians are consulting the latest evidence in their treatment.