Outpatient chemotherapy orders go digital, advancing move to electronic record


electronic records

St. Jude took another step in the shift from paper to electronic health records August 19 when chemotherapy orders from the Solid Tumor Clinic stopped coming in by fax and began arriving in the pharmacy electronically.

The clinic’s switch means all St. Jude outpatient and most inpatient orders are now handled electronically. While tasks like scheduling patient appointments and laboratory tests have been handled electronically for several years, the switch from written to electronic orders for patients receiving outpatient complex chemotherapy began about 10 months ago in the Neuro-oncology Clinic.

“We have an extremely safe paper process. The challenge was to maintain that safety and enhance it,” explained Jerry Shenep, MD, St. Jude chief medical information officer.

“Chemotherapy protocols are extremely complex,” said Sheri Spunt, MD, medical director of the hospital’s Solid Tumor Clinic. “Any error has serious implications for patient safety.”

The electronic environment has many safeguards. For example, the electronic system automatically checks for possible drug interactions or drug allergies and whether the patient and medication are on the listed research protocol. For medications that are dosed based on the patient’s size, the system automatically calculates the proper amount.

The new system, known as computerized provider order entry or CPOE, is part of a larger St. Jude push to convert to a completely electronic health record for all patients. Along with a medication list and treatment history, a complete electronic health record would include the patient’s health history as well as notes from specialists and staff detailing day-to-day patient progress.

The latest St. Jude milestone comes more than a decade after hospital officials committed to shifting to electronic health records. By late 2010 all new St. Jude patients are expected to have a completely electronic rather than paper record. Shenep predicts it will take until 2012 before complete health records of all active patients are fully electronic. Completing the switch will require scanning current paper records.

Federal health officials set a deadline of 2014 for hospitals and other healthcare providers to switch to an electronic system. Officials hope it will improve both safety and efficiency while reducing cost. Electronic records are also a priority for a growing number of private insurers and non-governmental organizations that rank quality of care.

St. Jude has advanced further in the switch to electronic health record than the vast majority of U.S. hospitals. For example, Shenep said St. Jude is the first of the 1,750 U.S. hospitals using an electronic health record developed by Cerner Corp. of Kansas City, Mo., to use an electronic system to manage complex chemotherapy orders.

Shenep said a St. Jude analysis completed in preparation for the switch to an electronic system for ordering chemotherapy identified 70 steps in the paper process. The analysis was directed by Don Baker, PharmD, Information Sciences, and James Hoffman, PharmD, medication outcomes and safety officer, Pharmaceutical Services.

In preparation for the switch, Information Sciences staff met with healthcare providers in the outpatient oncology clinics to review the paper process. The staff then created hundreds of computer-based medication order sets designed to bring each clinic into the digital era as easily as possible, explained Baker, clinical decision support officer.

Cancer treatment often involves three or four different chemotherapy drugs plus additional medicine to ease nausea and other side effects. Shenep said a patient clinic visit often generates more than 20 different treatment orders.

Along with improving patient safety, Spunt said ordering chemotherapy online should eventually speed treatment. Each week the Solid Tumor Clinic handles more than 100 visits of patients with neuroblastoma, bone and soft tissue sarcoma, Wilm’s tumor and other cancers.

“In the new environment, a medication order can be generated via computer and once approved electronically by a physician, go instantly to the pharmacy. There is no waiting for someone to fax it,” Spunt explained.

The electronic system also eliminates the need to decipher handwriting and makes it easier to track patients through chemotherapy, including the date of their last treatment and the total amount received.

Once the switch to electronic health records is complete, Spunt said physicians will be able to quickly and easily access the information they need to oversee patient care, even when they are away from the clinic. “We all understand the benefits,” she added.

August 2009


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