Oncology’s clinical computing needs are extremely specific and more intricate than many other specialties.’ Plus, care is subdivided into such areas as radiation therapy and chemotherapy that each has its own complex, iterative processes and documentation needs. Thus, it’s not surprising that few oncology vendors and products are available. However, a trend is emerging: Providers are co-developing new products or customizing existing products with vendor partners. At both Memorial Sloan-Kettering Cancer Center, New York, and Tennessee Oncology, Nashville, clinical IT leaders found the computing landscape wanting and decided to pioneer solutions themselves in collaboration with vendors.
Chemotherapy order entry
David Artz, M.D., medical director of information systems at Memorial Sloan-Kettering, says oncology care is a very complex environment, so when it comes to information systems, "We have something from everybody." The organization is one of the nation’s two largest cancer specialty centers (along with Houston’s M.D. Anderson Cancer Center), with 425 inpatient beds, 135,000 total annual patient days, 426,000 annual outpatient visits, and 8,300 total staff.
Memorial Sloan-Kettering uses the core EMR product from Eclipsys Corp., Boca Raton, Fla.; a patient record repository from LanVision Systems Inc./Streamline Health, Cincinnati; a PACS system from GE Healthcare, Milwaukee; and the BDM pharmacy system (now GE’s Centricity Pharmacy). But Artz and his colleagues have customized most of these systems for their own purposes.
For example, he says, "We’ve been working for the last two years with Eclipsys to create a version of that system that will work well with chemotherapy order entry." The customized version, especially satisfying in a sphere that has defied physician order entry, "will allow us to electronically provide a very uniform way of providing chemotherapy--a set regimen," Artz says. "There are immense advantages to us in having that capability combined with our core clinical system." The new product should be commercially available from Eclipsys in the next few months.
Cancer care EMR
The work to automate cancer care processes in progress at 40-oncologist Tennessee Oncology may be useful to other provider organizations as well. Oncology-specific electronic medical record (EMR) systems are scarce, says Tim Reeves, R.N., clinical information director. "I’ve been looking for an EMR for us since the beginning of 2001, maybe even 2000."
Neither off-the-shelf nor oncology-specific solutions were quite right, Reeves says. Senior IT director Alan Baldwin notes, "We found two oncology-specific modules that probably would have worked for us, but the architecture was dated." For example, one leading vendor is "still relying on Citrix servers and a proprietary back end, things that weren’t forward-looking, to my mind."
As a result, Reeves and Baldwin elected to work with Chicago-based Allscripts to customize its TouchWorks EMR for cancer care. Physicians made it clear that speed and ease of use were imperative, so a Web-based solution was the way to go. As one of the largest oncology groups in the country with 27 care locations, Tennessee Oncology found that the investments of time, effort and money have definitely been worth it, Reeves says. The solution is being rolled out in phases beginning March 2006.
Co-development, while successful, has not usurped application of existing solutions, however. For example, Francis Massimiano, vice president of sales at IntrinsiQ Data Corp., Waltham, Mass., notes that hundreds of hospitals use the clinical decision support, treatment plan, documentation and reimbursement reference tools in its core product, which has been available for 15 years. He’s skeptical about the idea of successfully customizing general EMR solutions, noting the extreme specifics of cancer care and time needed to develop complex niche systems (10 years for IntrinsiQ’s product, IntelliDose). Further, he says, most oncology modules recently developed by core clinical vendors have been failures.
Katie Madison, R.N., who runs the Vanderbilt-Ingram Cancer Center at Cool Springs, Franklin, Tenn., and is one of Massimiano’s clients, disagrees with him on the co-development issue. She believes that the kind of collaborative work being done at Tennessee Oncology (a competitor) is to be commended and is necessary for progress in oncology IT. "You need the combined expertise of both clinicians and IT experts" to create truly robust, workable systems, she says. Although Vanderbilt-Ingram has developed its own core clinical system, management of chemotherapy orders remains limited to inpatients.
Reeves is optimistic that more cancer care products will come onto the market in the next several years. "I’ve been looking at EMRs for five years," he says, "and I’ve already seen progress in leaps and bounds."
Mark Hagland is a contributing writer based in Chicago.