MOUNTAIN VIEW, CaliforniaIMPAC Medical Systems, Inc., an
oncology management software company launched 13 years ago in a Silicon Valley
garage, now has almost 1,700 clients worldwide, in 52 countries, including many
of the leading US cancer centers, as well as specialty treatment centers and
"We delivered our first system in the first quarter of
1991, about a year after we started the business," David Auerbach said in
an interview with ONI. Mr. Auerbach is cofounder and executive vice
president of IMPAC, and president of IMPAC’s international operations.
Joseph K. Jachinowski, cofounder, president and chief
executive officer (CEO), added, "At that time, an integrated application
having practice management, electronic medical records, and imaging features
under one umbrella was really a new thought, but to us, it seemed like the
logical thing to do."
Today, IMPAC offers a comprehensive information management
system that streamlines both clinical and business operations for oncology and
related specialties. The IMPAC system provides electronic medical and radiation
oncology charting, with integrated image management, practice management, and
cancer registry functionality.
Another key aspect of the system that started early in
product development at IMPAC was interfacing to outside systems. "Oncology
is typically a department or section within a larger health care
provider," Mr. Jachinowski said, "so the ability to exchange data
with cancer registries, labs, other hospitals, etc, was key to the viability of
Today, IMPAC provides the ability to connect to multiple
health care information and imaging systems via the Health Level 7 (HL7) and
DICOM standards. HL7 connectivity, for example, allows lab results to be posted
directly to the patient’s electronic chart.
"Our focus is oncology," Mr. Jachinowski said,
"but we also look at what we call the ‘synergistic adjacencies to
oncology,’ specialties that either feed patients into cancer care or provide
many services to cancer patients." For example, he said, the company has
now started to market systems to urology practices, because of the high number
of patients that come from urology into oncology.
James P. Hoey, currently chief operations officer, was the
third cofounder of IMPAC. The company is located in Mountain View, California,
with a development and support facility in Henderson, Nevada, a sales and
support office in Cambridge, Massachusetts, and international offices just
outside of London, England.
Electronic Medical Records
The core of the IMPAC management system is the electronic
medical record (EMR). IMPAC’s EMR provides all of the information found in a
typical paper chart and more. "Whereas a paper chart merely stores
information, IMPAC’s EMR is an active clinical tool that assists with
diagnosis and staging, provides links to online reference material, and alerts
clinicians of findingspatient allergies, contraindications, lab results, etcthat
warrant immediate review," Mr. Auerbach said.
The chart is available to authorized users on any PC
workstation, whether in the hospital or the physician’s office or home. IMPAC’s
image management system, for example, makes oncology-related medical images
available for immediate and simultaneous review by multiple clinicians.
IMPAC has added mobility to its EMR by providing the ability
to access the EMR securely via a personal digital assistant (PDA) or laptop
(via wireless Internet provider or any standard Internet connection) any time,
With IMPAC, clinicians can use portable pen-based tablets to
review the electronic chart, record data, and process orders at the bedside,
Mr. Auerbach said. This portability offers advantages to physicians using PhAST
Note, IMPAC’s structured noting system designed to help physicians document
patient encounters quickly and efficiently. PhAST Note also reduces the chance
of miscoding by suggesting the correct evaluation and management (E&M) code
based on the completed documentation.
The IMPAC system includes a library of standard chemotherapy
regimens that can be edited to conform to each center’s specific requirements
and expanded to include new regimens. Based on the assigned regimen, IMPAC
generates a treatment calendar complete with physician visits, chemotherapy
orders, required tests, and treatment sessions (see Figure).
Based on the patient’s body surface area or AUC and the
dose instructions, IMPAC automatically calculates the medication dose and
processes the order. If necessary, of course, clinicians can make adjustments.
Pharmacy orders are checked against regimen-specific toxicity limits to ensure
that cycle dose amounts are not exceeded.
Advantages for Nurses
In addition to recording the date and time that each drug
and dose was delivered, the nurse can fully document co-signatures, blood
products, route location, and vascular access device (VAD) details, and also
use a drawing tool to illustrate the site of a vesicant administration.
Mr. Auerbach pointed out that physicians and nurses involved
in clinical trials can custom design flow sheets and assessment forms to
evaluate specific regimens or disease types, or to add specific parameters for
pain management or quality of life studies, etc.
"You can set up the charts of patients enrolled in
studies to allow inclusion of additional family history, for example, or other
data that were not part of the standard chart," he said.
IMPAC integrates core business functions such as scheduling
and billing with the EMR. For scheduling, the system has an auto-find feature
that locates open timeslots and can provide "wave scheduling" to
schedule multiple appointments in virtually any pattern. A conflict checking
system prevents conflicts before they happen.
For medical billing, software tracks insurer authorizations
and alerts users of pending expirations or when limits are about to be
exceeded. It provides a systematic means of capturing billable procedures and
supplies. "Electronic charge management reduces the chance of
transcription errors, coding inconsistencies, redundant entries, or worst of
all, lost charges," Mr. Auerbach said.
Radiation Oncology Charting
The IMPAC system streamlines radiotherapy and intensity
modulated radiotherapy (IMRT) processes, from virtual simulation and the
generation of complete treatment prescriptions to the automatic set up,
verification, and recording of treatments. Treatment plans from any simulation
or planning system can be transferred to IMPAC’s EMR via the industry
standard DICOM RT format.
The IMPAC system provides a full set of cancer registry
tools, providing the ability to collect data to track patients post-treatment,
look at outcomes and quality of life, and report to state governments or other
central registries. The company maintains its own databasethe National
Oncology DataBase (NODB)currently with approximately 2 million cancer cases.
According to Mr. Jachinowski, it is "the most comprehensive longitudinal
oncology database available for cancer research today."