ReCAP: Feasibility Study of an Electronic Interface Between Internet-Based Survivorship Care Plans and Electronic Medical Records [Care Delivery]

QUESTION ASKED:

Can an interface be constructed to automatically populate an Internet-based survivorship care plan tool from the electronic medical record (EMR) in order to facilitate accurate and timely distribution of customized care plans?

SUMMARY ANSWER:

After a significant upfront investment of time and resources, clinical testing demonstrated that the integrated tool could be used for the population for whom it was designed.

METHODS:

An information technology application was developed to extract data from the EMR in use at our center (Epic). Data were transferred to auto-populate an Internet-based tool for creation of survivorship care plans (LIVESTRONG Care Plan) that had been previously used for creation of more than 35,000 plans.

MAIN RESULTS (OR WHAT WE FOUND):

The intended data (demographics, surgeries, chemotherapy drugs, radiation sites) were extracted from the EMR and transferred to the care plan platform without transfer of protected health information; customized survivorship care plans were created and transferred back to the EMR where they were housed as separate patient encounters.

This approach was tested clinically: survivorship care plans were created by nurse practitioners during scheduled clinic visits for 146 sequential, eligible patients (67% breast, 33% colorectal) with automatically populated data points reviewed by practitioners. Data entered into generated care plans were accurate in 97% of audited cases, and the process of care plan generation could be completed in < 1 minute.

BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:

This process required upfront resource investment and was customized to our institution. As the patient population expands outside of that tested in the setting of a feasibility study, several options may exist to address this limitation, including manual data entry, more complex information technology builds, and the use of a comprehensive tumor registry for expanded data access.

REAL-LIFE IMPLICATIONS:

The established feasibility of survivorship care plans fully integrated with an EMR at a major cancer center represents a tremendous milestone in the ultimate goal of care plan provision for all cancer survivors. This integrated technology has the potential to overcome the majority of barriers that have limited care plan use since it was first called for by the Institute of Medicine (IOM) 10 years ago, and allows clear vision of a method through which the ultimate goals of the IOM and Commission on Cancer may be reached in the very near future.

Table 1.

Data Elements Extracted From Electronic Medical Record With Brief Description of Location Within EMR Databases and/or Technique for Extraction

Element ExtractedMethod for Location Within EMRGenderExtracted from patient demographicsAgeCalculated from date of birth (extracted from patient demographics)RaceExtracted from patient demographicsCancer typeExtracted from the patient's active problem list and/or historical visit diagnoses; coded as ICD-9-CM diagnosis codesSurgeriesExtracted from procedure charges billed; coded as ICD-9-CM procedure codes (inpatient) and CPT codes (outpatient)Chemotherapy drugsExtracted from the medication administration record; coded as RxNorm concept unique identifiersRadiation typeNot present in EMR; extracted separately from radiation treatment planning systemRadiation indicationNot present in EMR; extracted separately from radiation treatment planning systemGenetic abnormality or syndromeExtracted from the patient's active problem list and/or historical visit diagnoses; coded as ICD-9-CM diagnosis codes

Abbreviations: CPT, current procedural terminology; EMR, electronic medical record; ICD-9-CM, International Classification of Diseases (9th revision, clinical modification).

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