Integrating Electronic Health Records into Clinical Pathways for Radiation Oncology Reduces Waiting Times

Clinical pathways that utilize electronic medical records (EMR) can reduce waiting times for patients and improve workflow integration in medical and radiation oncology, according to a recent study. 

Advances in technology and treatment strategies have helped to improve the prognoses of patients with cancer but have also significantly increased treatment-related costs. Therefore, hospitals and physicians face a critical challenge to optimizing cancer care delivery in coming years. 

In a study published in Practical Radiation Oncology, lead author Claude Sicotte, PhD (University of Montreal, Canada), and coauthors assessed how a broad-based EMR system integrated into all aspects of oncological treatment could impact patient waiting times and improve quality of care. 

In 2011, a hospital in Montreal, Canada, opened an ambulatory care center in a dense urban area. The center included a medical oncology department with spaces dedicated to chemotherapy, pharmacy services specializing in chemotherapy, and a radiation oncology department with 4 linear accelerators, devices used for precision radiation treatments. Developers of the center intended to find new ways of delivering better, more integrated care. To this end, significant investment was made to include EMR as a part of the full care continuum. EMR data are often used to support radiation care services but are rarely integrated across the entire workflow.  

A pre and post study design was used to assess the impact of the EMR system, which was deployed in 2011. Patients seen in the 7 months preceding EMR implementation (June 2010 to December 2010; n = 412) were compared with those seen in the 15 months after EMR implementation (May 2012 to July 2013; n = 1152). Researchers looked at the amount of time patients in these two groups spent waiting for treatment, because this measure has been linked to negative outcomes for patients. Waiting time was defined as the number of days between key steps in patient management preceding the first treatment received. These steps were broken up into different categorical indicators, such as time from consultation request to actual consultation, time from consultation to first treatment, and time from consultation to radiation treatment. 

Results of the study showed that average waiting times for medical and radiation oncology decreased over time, whereas surgical treatment waiting times remained unchanged. In medical and radiation oncology, there were statistically significant declines in waiting times of between 2 and 28 days. In addition, the waiting times for 5 of the 6 key steps identified by researchers improved, although only significantly for 3 of the 6 key steps. 

Further analysis showed that there was a steady increase in treatment volume for both medical oncology (12% increase) and radiation oncology (18% increase), indicating that, though more patients were treated at the center, waiting times were still improved through the use of EMR.

Ultimately, researchers concluded that the implementation of an EMR system had a positive impact on waiting times for care services for patients with cancer. In addition, the strategy implemented at the Montreal center, which was inspired by best practices for cancer care, is reproducible in other clinical settings. Researchers also stated that they would be interested in follow-up studies of similar EMR systems and their effect on metrics such as patient satisfaction, medical error rates, and cost effectiveness.—Sean McGuire 

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Sicotte C, Lapointe J, Clavel S, Fortin MA. Benefits of improving processes in cancer care with a care pathway-based electronic medical record. Pract Radiat Oncol. 2016;6(1):26-33.