LOS ANGELESIn the era of pay-for-performance in cancer care, the electronic medical record (EMR) is a "must-have" for maximizing practice efficiency. Without EMR, "we will not be able to collect the depth and detail of material that we need to argue for better reimbursement," community oncologist Linda D. Bosserman, MD, said at the "Advances in Oncology" symposium. Dr. Bosserman is president of Wilshire Oncology Medical Group, Inc., La Verne, California, and chief quality officer for CCE [Cancer Centers of Excellence] Partners, a not-for-profit company owned by oncology group practices committed to EMRs and to delivering quality oncology care using evidence-based protocols.
Dr. Bosserman emphasized that detailed data collection for quality assessment and monitoring is necessary to comply with the quality measures developed by Medicare, ASCO, and NCCN to ensure documentation of evidence-based treatment and follow-up, supportive and palliative care, and risk assessment and prevention. Dr. Bosserman, who uses EMR extensively in her practice, reviewed practice areas where EMR systems can simplify the data collection recommended by ASCO, NCCN, and Medicare. She noted that the demand for increasingly detailed data may require expanding the capabilities of current EMR systems.
Data on Disease Stage
An ASCO talk reported that 30% of Medicare patients did not have a staging notation on the patient's chart, she pointed out. ASCO recommends that oncologists measure the percentage of patients who have a stage and a TNM diagnosis noted on their charts.
The advantage of using an EMR system for data capturing, she said, is that "every patient has a diagnosis or numerous diagnoses of cancers, and the TNM goes with it automatically, as well as the cancer features." Another major ASCO quality guideline is to report pathology results on the patient's chart, which is a clickable item in the EMR used in Dr. Bosserman's practice.
Both Medicare and ASCO ask oncology practices to provide the percentage of chemotherapy plans documented, as well as doses and time intervals following initiation of treatment. ASCO also asks for documentation on number of chemotherapy cycles given. "When you have an electronic record, and you order, for example, dose-dense AC-T, you've ordered a specific dosing regimen and cycle number, so you will be 100% compliant with those ASCO QOPI (quality oncology practice initiative) and Medicare quality measures," she commented.
Signed informed consent to receive chemotherapy is another important ASCO measure, and becomes critical as increasing numbers of patients are treated with oral chemotherapy such as capecitabine (Xeloda), she said. In her practice, patients are informed by doctors, then have a detailed follow-up with oncology nurses for education about their treatment. The nurse provides a written treatment calendar, individual drug information sheets with review of common and uncommon toxicities, and follow-up information, after which patients sign a paper informed consent form and the nurse documents this in the EMR.
"We've developed an entire electronic chemo teaching form for the nurses, where they can rapidly check off the standardized teaching points and informed consent process as a document in the patient's record," she said.