Challenges to EHR Optimization for Cancer Programs—Workload, Cost, and Interoperability

By Joseph Kim, MD, MPH, MBA

While electronic health records (EHRs) remain a necessary component of care delivery, in a recent survey of ACCC Cancer Program members, 62% of respondents report that EHRs have increased the workload of their staff and 51% indicate that their EHR system has increased their total operating costs. Only 34% of respondents said that both medical and radiation oncology practices can interface with the hospital system. And about one-quarter (27%) report that neither medical nor radiation oncology practices can interface with the hospital system.

The survey was conducted for the ACCC Optimizing Electronic Health Records (EHRs) education initiative, which aims to help cancer programs identify ways to optimize their EHRs to meet the growing demands for accurate, integrated, comprehensive data capture and analysis.

ACCC conducted the survey (n=98) in early 2017 to assess members’ experience with their EHRs; 70% of respondents represented community cancer programs, 17% were from academic programs or NCI-designated cancer centers, and 11% were from outpatient oncology practices.

Among survey respondents the most common EHR systems in use were Epic and Cerner.

  • 47% have been using their current EHR system for more than 5 years.
  • 26% are actively switching to a different EHR system (either to Epic or Cerner).
  • The most common reasons for switching:
    ♦ To standardize EHR use across the entire health system
    ♦ To Increase data extraction and reporting capabilities.

While some EHR systems come with optional packages and add-on modules, others require their users to install third-party software.  According to survey responses, the most common add-on software packages are currently being used for:

  • Billing and coding
  • Survivorship care plans
  • Patient engagement and communication via patient portals.

In the current landscape, interoperability even within the same system remains a significant challenge. Specifically:

  • Only 34% of respondents indicate that both medical and radiation oncology practices can interface with the hospital system.
    ♦ 22% indicate that only medical oncology interfaces with the hospital system.
    ♦ 9% indicate that only radiation oncology interfaces with the hospital system.
  • 27% report that neither medical nor radiation oncology practices can interface with the hospital system.

The survey also asked respondents to rate different usability factors. Those receiving the highest ratings (i.e., most usable) were:

  • Entering patient information
  • Searching for medical information about a patient
  • Interfacing with the patient portal

The usability factors with the lowest ratings (i.e., least usable) were:

  • Ability to incorporate third party add-on modules
  • Customer service provided by EHR vendor
  • Making customizations within the EHR

Cancer programs rely heavily on their designated superusers, who often train new users, to provide recommendations or test new releases. Responses in several survey areas indicate that the increased use of scribes (also called clinical documentation specialists) may be a growing trend, especially for certain providers who may benefit substantially in their ability to see more patients.

Through this project, ACCC will be identifying real-world examples of how community cancer programs are optimizing their use of EHRs. Stay tuned for more project updates here.

Coming next, see what a focus group of ACCC members reveals about real-world challenges to EHR optimization.


Guest blogger Joseph Kim, MD, MPH, MBA, is serving as a consultant for the ACCC Optimizing Electronic Health Records (EHRs) initiative.  Dr. Kim is President of Xaf Solutions.

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