Haffty Consulting asks our Principal Consultant, Ann Walsh, Advanced Clinical Integration Specialist and Oncology Subject Matter Expert to share her experience in collaborating with clients on implementing MEDITECH’s Oncology solution across platforms. She shares her experience below.

According to the World Health Organization (WHO), cancer is the leading cause of death world-wide accounting for 1 in 6 deaths reported. Closer to home, the American Cancer Society (ACS) in 2023, estimated 1,958,310 new cancer cases and projected 609,820 cancer deaths would occur in the United States. With these statistics, the likelihood is that each of us will know someone diagnosed with cancer in our lifetime even if we are lucky enough not to have contracted cancer ourselves.

With the prevalence of cancer world-wide, integrated Oncology Information System solutions are now considered a “core solution” to effectively manage the complexity of the Oncology patient in the continuum of care. The benefits of an integrated Electronic Health Record (EHR) with Oncology, such as those provided by MEDITECH, play a crucial role in the management and delivery of cancer care within a cancer program. I have worked with clients that had a stand-alone Oncology Information System alongside the MEDITECH EHR. The challenge in this paradigm is the lack of integration of oncology data into the MEDITECH EHR, inefficient and redundant workflow processes developed that mitigated the safety features that an Oncology Information System provides. This is particularly true for managing chemotherapy regimens with the lack of integration to pharmacy.

Integrating Oncology within the MEDITECH EHR eliminates duplicate data entry which saves time and reduces errors associated with manual data input. With Expanse, there is integration with National Comprehensive Cancer Network (NCCN) for order templates and access to clinical practice guidelines considered the standard of care for Oncology in the United States, and for many countries around the world. Other benefits, aside from a centralized and comprehensive patient record with oncology-specific data (such as treatment plans), are workflow efficiencies related to scheduling; registration; coordination of care with other healthcare providers; integration with labs and radiology ordering; billing and financial management including tracking Authorizations; detailed audit trails; and enhanced reporting capabilities that an integrated system can provide.

With Expanse 2.2, the integration with MEDITECH’s Ambulatory allows for critical oncology data to display so providers in the community are aware that their patient has a cancer diagnosis and the treatment they are receiving. This is invaluable for the continuity of care.

Patient Safety is the most significant benefit of a robust, integrated EHR system with Oncology. Key safety features include:

• Multiple cycle order entry and verification for oncology treatments for weight-based medications including automated carboplatin calculation for area under the curve (AUC) orders, immunotherapies, and supportive medications.

• Multiple verification of chemotherapy orders (provider, nursing, and pharmacy) prior to transmission of orders to pharmacy allowing for dose adjustments or the ability to hold a medication or move a cycle based on the patient’s exam prior to administration.

• The ability to transition a cycle or a day within a cycle from outpatient to inpatient and back. This is essential to keep the enumeration of orders intact, and for managing the number of cycles given.

• Treatment plan documentation including all details related to prescribed medication.

• Bar code medication administration with patient identification and matching.

• Chemotherapy medication sequencing so medications appear on the MAR in the order of administration. Sequencing, available in 6.x and above, is critical in optimizing efficacy of the chemotherapy and help prevent cumulative toxicities that may arise from the administration of multiple chemotherapy drugs.

• Allergy and adverse drug reactions (ADR) alerts and drug-drug interaction checking.

• Tracking of lifetime dose caps viewable for clinicians to see prior to ordering or administration.

Over the years, we have learned critical lessons through the implementation of provider order entry systems. The 2009 HITECH act and meaningful use drove digitized provider ordering through the implementation of computerized provider order entry (CPOE). In its infancy, the systems were not as mature and there were notable errors associated with implementation, workflow, and the technology's maturity. The lessons learned over the years with provider order entry highlighted the clear benefits of provider ordering, alerts, integration and how to implement this technology for success.

Oncology has an elevated level of complexity with the chronic nature of the disease, inpatient and outpatient care, financial considerations, and the increasing demand of an integrated model with all the safety features essential for the care of this patient population. We also know from the lessons learned with provider order entry from years back, the risks of not having this technology in place. The benefits of an integrated system with oncology are incalculable in terms of patient care.

Oncology is the future in provider order entry and well worth the investment in time and resources to achieve a truly integrated model of care. The time has come to embrace technology and like provider order entry of years ago, the legacy of the investment will translate into a safer care environment for this critical patient population.

Please reach out to me directly at Haffty Consulting if you would like to transform the way your organization integrates Oncology into your practice. I can be reached via email at awalsh@hafftyconsulting.com.

About the Author: Ann Walsh has become one of the foremost authorities on implementing and optimizing MEDITECH’s Oncology Solution. With over 30 years in healthcare technology, she has first-hand experience of the evolution of system maturity that culminates in the specialized care setting of Oncology. Serving as the process lead for countless advanced clinical implementations and eight full scale Oncology implementations, she draws on her insights and experience to bring success to all organizations she works with.