Cancer Care Trends in the Community Hospital Cancer Center, 2008-2009

Section 7. EMR Systems

Section 7.1.  Use of EMR Systems

Section 7.2.  Selection

Section 7.3.  Resources

7.1. Use of EMR Systems

Sixty-five percent of respondents report utilization of electronic medical records, and of those using EMR, 47 percent use more than one software (Table 27). IMPAC Medical Systems’ MOSAIQ and Varian’s ARIA are the most frequently used. Radiation oncology departments frequently do need separate EMR systems because their needs are not met by whatever system the chemotherapy operations are using.

7.2. Selection

Selecting an EMR system for a hospital-based cancer center is a daunting task. Aside from the issues of capital and operating costs, the ideal system must meet the functional needs of the multidisciplinary cancer care team—medical oncologists, hematologists, radiation oncologists, surgeons, pharmacists, nurses, technicians, and administrative staff. Few systems can provide the breadth of functionality desired. Often, the cancer center must select multiple systems from multiple vendors, and attempt to "fit" the systems together. To eliminate redundant data entry by staff, the cancer center must stipulate that all vendors be able to exchange information through interfaces. Last but certainly not least, cancer center (or hospital) IT staff must have the skill sets to support the various technologies, the network, and all interfaces.

The specific clinical concerns of the oncology program may simply be beyond the capabilities of the hospital's information systems. An oncology-specific EMR can address these issues, including:

• Calculating the appropriate chemotherapy dose
• Tracking lifetime dosages of radiation and chemotherapy medications
• Keeping track of infusion preparation and administration
• Managing tumor staging
• Coordinating treatment protocols for combination therapies.

Oncology-specific EMRs will often have their own patient scheduling, order entry, clinical documentation, pharmacy functions, and billing components. If the hospital already has systems in place that take care of all or some of these functions, the hospital-based cancer center may choose not to implement certain elements in the oncology-specific EMR. In this scenario, the hospital-based information systems and the oncology-specific EMR must be set up to share data back and forth. Often this back-and-forth sharing of data requires specially developed interfaces.

7.3. Resources

• EMR for Hospital-Based Oncology Programs, Practical Tips and Strategies
• From Paper to Progress: EMR Implementation at Moses Cone Regional Cancer Center
• Hybrid EMR Systems: Another Option
• Medical Information Technology Vendor List