In April 2008, ASCO released
The Oncology Electronic Health Record Field Guide: Selecting and Implementing an EHR. John V. Cox, DO, MBA, Chair of the ASCO Electronic Health Records (EHR) Workgroup, spoke with
ASCO News & Forum about this new publication.
AN&F: How did the EHR Workgroup identify a need for a field guide publication?
Dr. Cox: One of the prime reasons for the group’s formation was the recognition that our members were beginning to make decisions about EHRs in their practices and there wasn’t a lot of information available to help them. The practice of oncology creates unique demands on an EHR. In producing a field guide, our goal was to mimic the success of an ASCO publication that helps in the business of oncology,
Practical Tips for the Oncology Practice. Our ultimate goal was to develop comprehensive content that could be a
Practical Tips-type guide for practicing oncologists and ASCO members on EHRs.
AN&F: What are some of the challenges involved in implementing an EHR?
Dr. Cox: First, there is a general group of problems that holds true for any physician practice adopting an EHR. EHRs will be “creatively destructive” because they force an office to look hard at basic workflows— how you check in a patient, how you handle a patient in an exam room, how you discharge a patient, how laboratories interface, how you write a prescription or document the visit.
A specific challenge in oncology is the infusion suite. We prescribe complex medications that have great potential for toxicity, and we want to have a very safe environment for that process. Implementing an oncology EHR can improve the safety of the practice. However, these gains in safety come only if oncologists are aware of the potential impact and pitfalls that are inherent with any large change. All personnel have to be aware of how an EHR can “destroy” the safety “valves” that are currently in place, and be alert to the need to reevaluate policy and procedure.
An oncology EHR also has to support the complexity of billing and the documentation for billing required by any oncology practice, whether in a university medical center, attached to a hospital outpatient center, or in a freestanding private practice. We all have very specific requirements related to billing and the EHR has to support them.
AN&F: How was the content for the guide developed?
Dr. Cox: ASCO brought together oncologists from varied practice settings who have had real-life EHR experiences, both successes and failures, and drew upon their experience. We were also fortunate to have the expertise of our practice management community represented in Elaine Towle, who I would hold up as being a singular voice. She called on several of her colleagues, the practice managers to whom we look for advice when dealing with complex decisions in our businesses. We drew upon the last year’s experience from the ASCO EHR Symposia, that included a great deal of exposure and feedback from the vendor community. (
Many of those sessions are available on the ASCO Virtual Meeting at ASCO.org.) I must also recognize the contributions of the ASCO staff and a professional EHR consultant, Carolyn Hartley. We feel that the field guide contents reflect the broad points of view that inform the multiple questions that an oncologist must work through in the decision process for an EHR.
AN&F: Who is the target audience for the guide?
Dr. Cox: Any oncologist faced with EHR decisions, regardless of the setting in which they practice, would benefit from looking through this field guide. The book quickly introduces the EHR lexicon and key concepts; readers at any level could pick this up and find it useful.
AN&F: How should people use the guide in order to get the most out of it?
Dr. Cox: As soon as you recognize you’re “in the game,” I would encourage you to obtain
The Oncology Electronic Health Record Field Guide from ASCO. It is fewer than 100 pages and a great first step would be to read it cover to cover.
At the end of every chapter are worksheets that can provide the foundation for a step-based approach through the process: in evaluating your needs for an EHR, considering your current workflow, and examining how that “creative destructive” process could affect you. There are worksheets that address budgets. There is an example of a “standard use case scenario”— as you ask vendors to come to your office and demonstrate their products, it’s very helpful to see a standard use case scenario that you ask them to follow. In addition, there is a worksheet that helps you grade these demonstrations and indicates the features you need to look at.
AN&F: Will the guide be updated in the future to reflect changes in technology?
Dr. Cox: We see this as a living document. The EHR community is changing rapidly, and I hope we will get feedback from our members. We encourage all readers to send their comments, particularly on the guide’s strengths and weaknesses, as they will inform future editions of the book.
To purchase the print or electronic editions of
The Oncology EHR Field Guide: Selecting and Implementing an EHR, visit
www.asco.org/ehrfieldguide. Feedback is encouraged and can submitted by e-mail to
ehr@asco.org.
ASCO Comments to Federal Agencies
ASCO submitted comment letters to federal agencies on the following topics:
FDA Rules for Advisory Committee Members—ASCO sent the U.S. Food & Drug Administration (FDA) comments in response to its issuance of two draft guidance documents on the public availability of advisory committee member conflict of interest (COI) disclosures and waivers and advisory committee voting procedures. The comments were generally supportive of the changes and renewed an earlier request that the FDA revise the draft March 2007 guidance for determining COI and eligibility for participation in advisory committee meetings to ensure balance between appropriately managing conflicts and having the necessary expertise on FDA’s advisory committees.
FDA Science Board Report—ASCO submitted comments to the FDA on the report of its Science Board entitled “FDA Science and Mission at Risk,” stating that the FDA should increase collaborations with professional societies to better address its scientific needs. ASCO has already collaborated with the FDA to hold meetings with groups of experts to discuss issues such as clinical trials endpoints and alternative trial designs and also provides educational opportunities for FDA experts through its Annual Meeting, thematic meetings, and workshops. ASCO also encouraged the FDA to strengthen its relationships with other federal agencies governing cancer research and treatment.
HHS Report on Oversight of Genetic Testing—ASCO sent comments in response to the Department of Health and Human Services’ (HHS) Secretary’s Advisory Committee on Genetics, Health and Society’s (SACGHS) draft report on the U.S. system of oversight of genetic testing. ASCO commended SACGHS’ special attention to the analytical and clinical validity of genetic tests; however, it noted several areas in which the report does not go far enough in ensuring test validity.
Medicare Hospital Outpatient Payment Rule—ASCO submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Hospital Outpatient Prospective Payment System final rule for 2008. ASCO expressed concern about the practical implications certain final rule decisions will have on access to cancer care. ASCO’s comments focus on three main policy topics of concern:
- Reduction in payment for drugs and biologics in the hospital outpatient setting
- Increased packaging of drug and biologic therapies
- Payment for therapeutic radiopharmaceuticals
Medicare Clarification on ESA Coverage Decision—ASCO sent a letter to CMS asking the agency to clarify its instructions to carriers about how to implement its National Coverage Decision on ESAs. ASCO’s primary concern is a statement in carrier instructions declaring that claims for ESA use should always be denied “when a hemoglobin 10 g/dL or greater or hemocrit 30% or greater is reported.” This instruction is not consistent with certain provisions in the coverage decision.
NIH Peer-review Process—ASCO submitted comments to the National Institutes of Health (NIH) in response to a draft report on its peer review system. The report identifies the most significant challenges facing the NIH peer review system and proposes recommended actions. ASCO applauded proposals aimed at enhancing the pool of peer reviewers, including permitting more flexible review service, providing more flexible grant submission deadlines, and linking study-section service to the most prestigious rewards. The Society also was pleased that the self study includes strong recommendations for enhancing the funding of early career investigators.
The above letters are available by contacting the Cancer Policy and Clinical Affairs Department at
publicpolicy@asco.org.
