"For many physicians, free-text documentation is the preferred way to capture the complete patient story. Although oncologists were capturing cancer-specific details (such as staging data) in the EHR, they were doing so in the form of free-text notes. This practice resulted in inconsistent, unstructured data that could not be used to analyze care or outcomes."
- Anne Marie Bickmore, RN
Despite all the advancements in technology, science, medicine, and a myriad other fields, cancer remains a devastating factor that causes damage to billions of people the world over. It's hard to even find someone who hasn't been affected by the disease - either family members, friends, or coworkers they've known have been diagnosed or suffered its ill affects in some manner. Unfortunately, it doesn't look like it's going to get any better as the Institute of Medicine is projecting 18 million cancer survivors by 2022 with cancer incidence expected to grow to 2.3 million by 2030. What can be done in the face of this rising tide? What is the best way to discover and enact the treatments of today to prevent the heartbreak and torment of tomorrow? The answer lies not just in administering care, but effectively capturing how we are administering that care.
In an excellent post by registered emergency department nurse Anne Marie Bickmore for Health Catalyst, Ms. Bickmore describes how defining, capturing, and charting specific points of data led to an increase in cancer information retention and a possible improvement in cancer care and outcomes. Using an electronic data warehouse (EDW) and business intelligence tools, the hospital defined specific fields that all physicians had to complete when documenting their cancer cases. These responses were then saved in the warehouse and used to show which treatments were employed and the effectiveness of that treatment.
This information was always supposed to be captured - and indeed, many physicians probably thought they were capturing it previously. However, by adding structure that forced physicians to enter in specific responses in unique fields, administrators were able to demonstrate what hasn't previously been documented. This changed the way the physicians were reporting and encouraged them to include the specific data points going forward. By seeing the gaps in their reporting, it changed their behavior; that change in behavior changed their documentation, which, in turn, may change behavior again by influencing treatment decisions. It's a cycle built on feedback that is constantly refining and moving towards better care for patients.
Another aspect that this structured data capture helped is that it made it easier for the facility to track which treatment protocols physicians were using for their patients. As Ms. Bickmore explains, "although the hospital had preferred protocol templates, the data revealed that physicians’ customization had resulted in several hundred different templates being used." But since the information was previously unstructured text, it was harder to determine which protocols were being followed and what the effects were for the patients. Presented in itemized fields, it becomes much clearer where deviations had occurred and why. This allows the facility to refine their preferred protocols to suit any effective treatments that stemmed from these different templates. But it also encourages physicians to realign themselves with the best practices that had been previously set out. By freeing the information from the shackles of rambling paragraphs and making it very easy to visualize, the facility was able to see exactly what their program was doing, the outcomes of those actions, and communicate its needs and plans to physicians backed up by data. But again, the first step in making any of these changes - or even in recognizing what changes have to be made - is to capture the data in a way that makes it usable by electronic systems.
It really is a great post and I encourage everyone to read the PDF version (found here) which includes a lot more information, including the methods they used and the results they arrived at. I've said it before, but it bears repeating: Tomorrow's treatments are built on today's data. By collecting these fields and responses, and providing a more uniform approach to documentation, physicians are able to ensure the quality of the information they are capturing while increasing adherence to best practices. Effective treatment begins with informed and empowered physicians - and with these advances in structured reporting, we've taken a strong step forward in the fight against cancer.