Some oncologists at Dana-Farber Cancer Institute have a hypothesis: Patients will more accurately report the ill effects of treatment if they can do it in real time. To test this hypothesis, beginning this September, some patients will use their home Internet connections to record instances of nausea, fatigue, and other treatment-related symptoms into their individual Dana-Farber electronic medical record (EMR).
"We need to know the true toxicity of the treatments we're delivering if we want to do a better job of controlling it," says Dr. Lawrence Shulman, the cancer center's chief medical officer.
Dana-Farber is just one of many large health care systems that have developed their own EMR systems and are finding innovative uses for them. Now the U.S. Department of Health and Human Services (HHS) is trying to make sure that all Americans have their own electronic health records by 2015.
HHS Secretary Michael Leavitt announced the effort earlier this month. Much like an ATM card can be used at nearly any ATM machine across the country, the EMRs would be accessible, with the appropriate security measures, at any medical facility. Their development will be driven by a national public-private sector collaboration that establishes essential items such as data standards, IT structure, and privacy and security policies, Sec. Leavitt said.
While the data on the potential impact of EMRs are limited, many health care experts believe their widespread use can improve care and save money. The latter is no trivial matter. Current estimates put the annual U.S. health care costs at approximately $1.8 trillion, more than 15 percent of the nation's gross domestic product.
The EMR used at the University of Texas M.D. Anderson Cancer Center, dubbed ClinicStation, was launched in 2001, primarily to provide the cancer center's clinicians with easy access to the millions of clinical images produced during the standard course of care and research. Over time, though, it has morphed into an internally developed EMR to address the complexity of research-driven patient care.
"All clinical data are now reviewed through ClinicStation," explains Dr. Kevin W. McEnery, associate division head for Informatics at M.D. Anderson. "There is no paper chart. If somebody wants to review a patient's clinical data or clinical notes, they review it through ClinicStation."
The system is available on more than 7,000 desktops at the institution, and about 6,500 caregivers use ClinicStation. In May, there were almost 60 million transactions on the system. More than 1 million imaging studies and 100 million individual images dating back to November 2000 can be instantly accessed through the system.
Although no formal study has been done, officials at M.D. Anderson estimate ClinicStation will save the institution anywhere from $8 million to $30 million by the end of the decade. They also believe the system has improved the quality of care.
"Patients at M.D. Anderson all receive multidisciplinary care, where routinely several physicians are involved in the management of a patient's care plan at the same time," Dr. McEnery says. "With ClinicStation, these physicians can efficiently collaborate in a patient's care because they have simultaneous access to the same information."
Dana-Farber shares its EMR with its seven sister institutions, including Brigham and Women's Hospital and Partners HealthCare system. In addition to information including patients' laboratory data, pathology and radiology results, medications used, and office notes, the EMR also includes oncology-specific modules, such as infusion flow sheets for chemotherapy and blood products.
"Every bit of data on a patient in any of our institutions is collated in reverse chronological order," Dr. Shulman says. "For us, it's very important, because many patients often go back and forth between the different institutions."
As the Dana-Farber toxicity study illustrates, EMRs have potentially broad research applications. The NCI-funded Cancer Research Network (CRN), a coalition of 11 managed care systems that collectively has more than 10 million enrollees, is already using EMRs to perform several studies.
CRN investigators recently used EMRs to examine the relationship between screening practices and late-stage diagnoses of breast and cervical cancers in CRN systems. More than half of late-stage cervical cancer diagnoses, they found, were attributable to failure to undergo screening in the 3 years before diagnosis. Women in specific subgroups had a greater likelihood of falling into this category. The participating managed care systems are now designing interventions to increase screening among plan members from those subgroups, explained Dr. Edward Wagner of the Center for Health Studies at the Group Health Cooperative in Seattle during a recent presentation on the CRN to NCI's National Cancer Advisory Board. In another CRN study, EMRs are being used to provide individualized feedback to primary care physicians on their provision of smoking cessation services.
If the goal of a secure but easily accessible EMR for every American can be achieved, that will mean big things for cancer research and care, according to Dr. McEnery.
Among other things, when patients travel to a tertiary care center, it would eliminate the hours spent reviewing outside paper records for information. In addition, he adds, because everything about patients' treatment at the cancer center would be captured in their records, "patients will experience more efficient care in their own hometown from their own provider."
By Carmen Phillips
