“Treating the Person: Integrating Support Services into Clinical Pathways” at the Clinical Pathways Congress with the Cancer Care Business Exchange

The CPC and CBEx Annual Congress, on October 6-8, creates an interactive environment for cancer care stakeholders to explore and share practical approaches to relevant issues. 

Mary Cooley, PhD, a nurse scientist at the Dana-Farber Cancer Institute, and David Lobach, MD, vice president for health care research at Elimu Informatics, provide an inside look into their CPC session “Treating the Person: Integrating Support Services into Clinical Pathways.”

This teaser video discusses the innovative aspects of a decision-support system for symptom management in health care, highlighting key advancements and the challenges of implementing the system into electronic health records. 

Register today to improve your knowledge about decision-support systems and how they can be implemented into EHRs to improve workflow. 

Transcript: 

David Lobach, MD: I think some of the exciting components of what we're doing is that we're providing some of the most advanced decision support that I have seen in the marketplace in this area, and it's advanced in a couple different ways. One is to the degree that we're able to engage patients and understand the context of their situation before we seek to manage it. The second part is we've added a safety component in the workflow where clinicians are asked to review critical data elements, that if they're incorrectly recorded or used in the algorithms, they could give erroneous information. So there's two ways that I think we've taken this whole process of symptom management or computer assisted symptom management or pathways to a new level.
    The other things that we're excited about talking about is that we've actually done real implementations of the systems at two health within two cancer centers, and we've really learned a lot about what it takes to get these types of systems actually functional in the context of the electronic health record. And it's not as easy as one might hope or think. We've used standardized approaches so that we can have portability and scalability, but the standards haven't lived up to what we might want to expect. And we've learned a lot about how you need to get the data that's required from the EHR to inform the algorithms, and those are some of the types of things that are really rubber hits the road issues that we hope to be discussing and presenting during our talk at the meeting.

Mary Cooley, PhD: One of the things I'm excited about is David and his group are really some of the leaders in this area of implementation into the EHR, and just some of the lessons learned and how to make this successful in the future is one of the things that we're excited to share. And I think this work that we've been doing is innovative and timely because a lot of the symptom monitoring approaches have only provided information to clinicians about patient reported outcomes and the severity, but it doesn't really provide specific instructions at the point of care to really improve symptom management that's concordant with guideline based care. And being able to do that in the current environment is challenging and difficult, and David and his group really are the leaders not only nationally, but internationally in this space.

Dr Lobach: I want to acknowledge Mary and her team and that they have really been experts in this whole process of managing symptoms in alignment with evidence-based research. And she's really an expert, particularly in this issue of co-occurring symptoms, which is really the actual situation. It's rare that someone has just one significant symptom when you're in the situation with cancer treatment. And I think the second thing that we've done and really has been involved both of our teams that we hope to be able to talk about and share, is we've really sought to ensure that we fit into the workflow of both the patient and the clinician, and that's one reason we've opted to use texting because that is an easy workflow for the patient to engage.
    Patient portals just have not been successful because that's not a very acceptable workflow for most patients. And the second piece for the clinician is that we've sought to integrate the application that gives symptom management guidance directly into the EHR, so it looks like it's actually part of the EHR and we're using the standard-based approaches to doing that. It's referred to as SMART on FHIR where our external application looks like it's part of the native EHR, so the clinician could just very smoothly move into it and move out of it just as they're doing their regular work. So the symptom management can be just a part of the standard workflow, and that is overcoming one of the barriers as to why symptom management tools have not been used very regularly, is because it's usually been a second tool that someone has to go open and access. Whereas now, by integrating it into the workflow, we're hopeful that we have a solution that'll really make this whole process much smoother and much better and much more usable.

Dr Cooley: I'm really looking forward to this venue because it brings together folks that are all really interested in the same area of how to integrate best practices into workflow and improve the quality of care. So, it should be a great venue for us to participate in.

Dr Lobach: We are very excited to be a part of this community because it really is where the rubber hits the road, and that's what we feel is important about the work we've been doing is we're really trying to make an applied, functional, pragmatic solution to improving cancer care for symptoms. It's just an area that there's been a huge need, and that's why we've been sponsored through a contract from the National Cancer Institute to do this type of work.