Electronic health records (EHRs) can improve the ability to diagnose diseases, reduce medical errors, and improve patient outcomes. However, data collection platforms are only as good as their design and usability. If designed well, EHRs can even reduce administrative burden, but they have to be easily adaptable into the practice workflow. Merging quality clinical pathways or other decision-support tools with EHR platforms can enhance care delivery and data collection even more, leading to better patient outcomes and richer data sets. The feature articles in this issue center around evolved uses of the EHR and making the most of collected patient data, specifically real-world data.
Patients with urothelial carcinoma (UC) may incur significant lifetime costs depending upon the stage of the cancer and the type and extent of care received. In their study, Abdalla Aly, PhD, and colleagues investigate the real-world lifetime costs among patients diagnosed with UC as they go through their disease journey from diagnosis and treatment to recovery and end of life. These lifetime costs are reviewed from the time of diagnosis and and stratified by stage from the payer’s perspective. Patients ≥66 years with newly diagnosed UC from 2004-2013 were retrospectively identified using the linked Medicare Surveillance, Epidemiology, and End Results (SEER) database. Patients were followed from UC diagnosis to death or last follow-up to estimate lifetime costs. Costs were allocated to three phases: diagnosis, terminal, and continuation. Their findings provide a contemporary. detailed update of the lifetime economic burden of UC by adopting a phase-based, stage-dependent approach.
Fragmentation of care across multiple health care systems is a challenge for data collection and analyses as well as for clinical pathways. Especially in rural settings, fragmentation can compromise timely, evidence-based, equitable, and high-quality cancer care. Helen M Johnson, MD, and colleagues added a variety of enhancements to their EHR to improve the quality of their breast cancer care delivery in their rural hospital system. By multidisciplinary consensus, they developed evidence-based clinical pathways and quality metrics for breast cancer care. They updated the EHR with the intent of using it to use as a tool for promoting adherence to clinical pathways and facilitating continuous quality improvement. In addition, a system-wide multidisciplinary Virtual Breast Cancer Conference (VBCC) was operationalized. A standardized VBCC template was purposefully designed for integration into the EHR and included clinical pathway elements as discrete variables to facilitate rapid analysis and continuous quality improvement. They provide preliminary findings and lessons learned thus far in this project, noting what interventions are on the horizon, such as added EHR triggers.
This issue also features select conference coverage of the fully virtual Community Oncology Alliance Annual Meeting that took place in April 2020, with full coverage available online.
