BETHESDA, MD 30 November 2012—The implementation of a pharmacist-developed chemotherapy regimen library at the Cancer Institute of New Jersey (CINJ) in New Brunswick has increased by 10-fold the number of standard treatment regimens at clinicians' fingertips.
"This provides a way to standardize how cancer is treated at our institution," said Adam Lisi, pharmacy informatics specialist at CINJ.
Lisi developed the library as part of the cancer center's rollout of an electronic medical record (EMR) system, which began last year.
With the adoption of the EMR system, he said, clinicians no longer rely on static "electronic paper," or PDF documents, that describe treatment regimens. Instead, the regimens are incorporated into the EMR, which alerts clinicians to potential problems, such as laboratory results that may necessitate a change in drug therapy.
Lisi said about 500 standard chemotherapy regimens have been incorporated into the EMR, and clinicians can ask to have additional regimens added.
CINJ is 1 of 41 National Cancer Institute-designated comprehensive cancer centers in the United States. Including return visits, the center logs about 90,000 patient encounters each year. In addition to using standard treatment protocols, the center enrolls more than 2,000 adults and pediatric patients in clinical trials each year.
According to CINJ, data captured in the EMR system can produce a detailed picture of each patient's status and allow clinicians to make better treatment decisions.
Lisi said CINJ clinicians use the EMR system for all patients receiving standard therapy. He said the center hopes to expand the system's use to include clinical trial participants, who require more extensive records than patients on standard therapy.
The ability for informatics specialists like Lisi to create customized regimen libraries is built into Varian Medical Systems' ARIA oncology information suite, which is the EMR platform adopted at CINJ.
"We use this system for scheduling and billing and anything that involves order entry," Lisi said. He said the order-entry modules are well-accepted by the staff, and CINJ is working with the vendor to fine-tune other parts of the system.
Lisi noted that federal incentives are driving the adoption of EMR systems, in general, but he said this was just one factor in CINJ's decision.
"Of course, it makes everything safer if you go electronic," he said.
Participants at a workshop convened this past February by the Institute of Medicine named robust EMR systems as part of an overall informatics landscape that is needed to improve cancer care. The workshop focused on informatics challenges in cancer research but also discussed technology used in everyday clinical practice.
According to the summary, the most successful informatics tools will be "those that integrate research and clinical data i
n an organized and efficient manner."
The summary states that advances in genomics, in particular, have contributed to an explosion in the volume of data on patients with cancer. To improve patient care, this data must be incorporated into EMRs and other databases, along with high-quality, standardized data on patient demographics, tumor characteristics, treatment responses, and other pertinent information.
The workshop participants called for the National Cancer Institute to align its informatics efforts with EMR-adoption incentives overseen by the Office of the National Coordinator for Health Information Technology. One possible goal for this would be to produce public libraries of decision-support tools that would allow any oncology practice to successfully care for patients on clinical trial protocols.
Estimates on EMR adoption released this year by agencies of the U.S. Department of Health and Human Services indicated growing acceptance of the systems. According to the Office of the National Coordinator for Health Information Technology, 38% of nonfederal acute care hospitals had adopted an EMR system last year, nearly double the figure from 2010.
The Centers for Disease Control and Prevention announced this past summer that 55% of office-based physicians had adopted an EMR system last year, and half of those without an EMR system planned to adopt one within a year.
Federal data did not include an estimate of EMR adoption in oncology settings. According to the Institute of Medicine summary, about 80% of patients with cancer receive their care at community oncology practices.