Automated Oncology

Patient safety is our top priority at Baltimore-based LifeBridge Health. It’s our responsibility to ensure that we have strong processes in place to prevent mistakes. And when it comes to cancer care and chemotherapy treatments — there’s absolutely no room for error.

That’s why, four years ago, our oncology practice made an important decision to do away with hand-written prescriptions and manual processes and move to a far safer approach: IntelliDose — a computerized physician order entry (CPOE) system for effectively tracking and measuring chemotherapy treatments and other medications for cancer patients.

The Problem

LifeBridge Health had big plans to grow aggressively and become one of the leading oncology care hospitals in the Baltimore area. We already had hundreds of cancer patients coming to our hospital every month for treatment, and our goal was to double or triple the number of patients our practice could serve. But fast growth coupled with hand-written chemo orders and faxes coming from multiple locations would be a recipe for disaster.

In addition, LifeBridge Health has two hospitals in Baltimore: Sinai Hospital and Northwest Hospital. We wanted to expand our oncology practice to offer infusion centers at both locations. Relying on paper records would make it incredibly difficult to keep track of and share critical patient information across two locations. We were concerned about risk, patient safety and efficiency.

We needed an electronic solution that could carefully and accurately track each patient’s visits, treatments and dosing; provide total visibility throughout our medical oncology department; and, track total drug doses including cumulative dosing for each patient to avoid unnecessary drug toxicity. The solution also needed to bridge the communication gap between physicians, nurses and pharmacists with a single system of record for every cancer patient, in addition to providing immediate access to a patient’s most up-to-date medical history.

The Solution

The criteria was crystal clear from day one. We needed a way to quickly, accurately and electronically track the order entry and documentation of medications for every cancer patient on our watch — across two very active hospitals to ensure patient safety, process improvement and practicewide communication.

Our goal was to eliminate hand-written orders and paper charts, leaving no room for misinterpretation. We also wanted to improve processes and have one central location for tracking information on cancer patients, as well as complete visibility across the entire department so everyone would know what was going on with any patient at any time.

We looked at multiple technology solutions and selected an oncology-specific CPOE for its ability to automate chemotherapy orders; track the most complex treatments, cumulative doses, supporting medications and patient history; develop specialized treatment plans to ensure standardization and cost-effective chemotherapy administration; provide nurse medication charting that conforms to both Joint Commission and Oncology Nursing Society standards; and, enable real-time clinical information integration with our core applications — including Cerner.

The Implementation

Our goal was to have the entire medical oncology group trained and up-and-running, tracking cancer patients and administrations electronically, within three months. The roll-out started in Sinai Hospital, and within six months, we decided to expand to Northwest Hospital. Two groups were involved from the start — the physicians and the pharmacists — who immediately saw the value in moving to an electronic order entry and documentation approach. During implementation, the biggest challenge we faced was getting the infusion nurses on board.

The nurses were the only critical oncology staffers who weren’t involved in making the decision to go paperless. We faced some strong resistance at first because the process changes required to successfully shift from paper to electronic tracking had an enormous impact on how the nurses did their jobs. Within 30 days of being up-and-running at each facility, all three groups were electronically tracking chemotherapy treatments (and related medications) for every cancer patient at LifeBridge Health.

In addition, nurse practitioners, physician’s assistants, GYN oncologists, the clinical trials team and even members in the billing department were signing-on for the latest information on cancer patients in the hospital’s care.

Results

In going paperless, we’ve dramatically grown our oncology practice at LifeBridge Health from treating roughly 600 patients to nearly 1,700 patients every month. We’ve also doubled our staff of oncology experts, and we are now one of the largest oncology care centers in Baltimore.

Implementing an electronic order entry system helped us standardize the quality and delivery of care throughout our oncology practice. It organizes the way we document administrations and create templates based on treatment patterns to help our practitioners determine the best possible treatment plans for cancer patients. It also provides critical safeguards that require “double sign-off” on every single chemotherapy order before it can be administered.

Most importantly, we have a strong system in place that we trust to ensure patient safety, operational efficiency and that optimal treatment decisions are made as we continue to grow. Before IntelliDose, we lived with the ever-present concern that we would have a miscalculation that wouldn’t be caught in time, despite our redundant processes and experienced staff. But now, errors are not even making it as far as the pharmacy.

Now, new cancer patients can instantly access their records to determine the optimal treatment plan. If chemo is needed, the first infusion visit is scheduled and the physician initiates the drug order, which is automatically sent to the pharmacy department. Every visit, treatment plan, infusion, change in therapy, reaction and supporting drug is tracked in a single, electronic system of record.

When a patient crosses from one hospital to another, the physician or nurse can quickly access that patient’s entire treatment history and dosing without having to pull up multiple records or paper charts. There’s now a unique, complete, electronic record of every cancer patient that visits LifeBridge Health for care.

Linda J. Rogers, RN, is administrative director at LifeBridge Health’s cancer institute. Contact her at (443) 777 – 2512.

February 2009