A retrospective study presented at the 2025 National Comprehensive Cancer Network (NCCN) Annual Conference evaluated how embedding a clinical decision support (CDS) tool within the electronic health record (EHR) can enhance specialty drug management by improving prescription capture, a key metric for comprehensive medication management.

The study focused on Flatiron Assist (FA), an EHR-embedded CDS platform that allows for customization of treatment preferences in alignment with NCCN guidelines. Investigators at Hematology Oncology Associates of Central New York (HOACNY) examined the impact of labeling zanubrutinib—an oral tyrosine kinase inhibitor with a category 1 recommendation for chronic lymphocytic leukemia (CLL)—as “HOACNY Preferred” in FA. They compared prescribing trends for zanubrutinib and the similarly recommended acalabrutinib across oncologists at HOACNY from January 2022 through October 2024.

Following the June 2023 implementation of the “HOACNY Preferred” designation within the CDS tool, the proportion of zanubrutinib prescriptions rose dramatically, from 16% to 81%. This shift reflected a substantial increase in in-house pharmacy prescription capture, which contributes to financial sustainability and enables timely, integrated patient care.

Specialty drugs account for more than half of all pharmacy spending in the US, with oral cancer therapies contributing significantly to both the cost and prescription volume. These medications are often dispensed through specialty pharmacies operating under open or limited distribution networks, which can limit access for in-house pharmacy teams. However, in-house pharmacies play a critical role in supporting comprehensive care—facilitating prior authorizations, managing dose changes, and minimizing errors and delays through integration with EHR.

The findings support the value of customizable CDS tools embedded within the EHR to align clinical and financial decision-making. By highlighting locally preferred options that meet national guidelines, these tools empower oncology providers to make informed treatment selections at the point of care, ultimately advancing value-based care goals through improved access, adherence, and cost management.

Reference

Congelli JM, Bolha A, Maniago R, et al. Improving patient access and adherence: the role of an electronic health record (EHR)-embedded clinical decision support (CDS) tool in specialty drug management. Presented at: 2025 NCCN Annual Conference; March 28-March 30, 2025; Orlando, Florida, and virtual.