Increasing Epic staging module adherence in an academic cancer center.

Abstract

64 Background: Documenting tumor staging (TS) is an important quality measure from ASCO’s QOPI program as a useful Core component of care. Real-time, actionable TS documentation in structured fields is important to identify patient cohorts for value-based measurement and to trigger patient care interventions. TS at our institution was usually documented in plain text progress notes in our electronic health record (Epic, Verona WI), making it difficult to use for automating support services, clinical trial evaluation, pre-authorization, business operations, value-based initiatives, and clinical research. Methods: Entry of TS into structured fields in the Epic Staging Module was agreed upon as an internal cancer quality measure in Fiscal Year (FY) 16 (9/15 – 8/16). Patients with > 2 visits to an oncology outpatient department and who began surgical, radiation or chemotherapy treatment in the reporting month were included. The physician providing the first treatment was accountable. Monthly physician and patient-level reports were provided to physician leaders, in a phased roll-out. Targets were based off FY15 performance, which were doubled for a minimum of 40% and maximum of 70% adherence. Results: Nine cancer care programs (CCPs) participated. Average compliance increased from 24% in 9/15 to 79% in 8/16. 2089 of 2894 (72%) charts had clinical and/or pathologic TS entered in the Module. Adherence was driven by CCP leaders sharing data and allowing advanced practice providers staging privileges. We uncovered discordance among providers on what clinical information to input into the Module: original diagnosis or presenting diagnosis on which to base treatment. Conclusions: Our multidisciplinary care teams improved our ability to capture TS at first treatment. A rolled-out, rather than big-bang “hard stop,” approach was successful, as we uncovered unexpected flaws in the system including aligning clinical and staging privileges with Epic access privileges, inaccuracies in Module implementation, and unclear definition between stage and disease state. There are deficiencies in the current AJCC staging system, particularly in its use for relapsed or recurrent cancer, which make defining real-time actionable processes difficult.