Clinical Pathways Expanded to Include Data Collection and EHR Management at Geisinger


That’s what Mark Wojtowicz, MS, MBA, executive director of oncology research and innovation at the Geisinger Cancer Institute in Danville, Pa., Shared during a session of the Association’s 47th Annual Meeting. of Community Cancer Centers and the Cancer Centers Trade Summit in March.

Geisinger implemented the Elsevier ClinicalPath in Medical and Radiologic Oncology in April 2019, starting with a “soft demo” and a week-long training process. The course product was rolled out to all sites a month later. The healthcare system decided to integrate ClinicalPath into its Epic electronic health record management (EHR) system, as incorporation into the workflow was seen as key to getting physicians to embrace pathways.

Pharmacists oversaw a process in which the drug regimen library was “aligned” with Epic to systematically update new hematology and oncology workflows. This was a key process as Geisinger is actively involved in clinical trials.

“Participating in clinical trials is an important part of what we do, and we know it means a lot that our clinicians have information about clinical trials at this decision point,” Wojtowicz said. To make all options available when clinicians talk to patients, “we wanted to implement all of these specialties, and we wanted to do it as quickly as possible.

“A lot of the credit goes to the team who really made this possible.”

The software demo was the key, Wojtowicz said. “Everyone was at the start line, [and] the tool has actually been launched; he just wasn’t promoted to the general practice of being live and accessible.

During this time, the Champion Physicians worked with the Pathways to gain buy-in from others and allow time for adjustments and integration with other workflows. A month later, the new program was ready to go live. For a week, the pathways team met with clinicians and let them try out the pathways system to give them training and practice opportunities. Wojtowicz shared a decision tree slide that showed each step, starting with whether or not a diagnosis was on a lane. The mapping system was essential, he said.

“We know that clinical pathways will often not cover all of the existing scenarios or all of the decisions an oncologist must make,” Wojtowicz said. “So you have to be able to map that – what does this path look like? Or what do those workflows look like when it comes to a non-journey decision versus journey? “

This visualization process allowed the team – and by extension, the doctors – to think about what the workflow would look like and helped with the implementation.

Integrating medical oncology workflows with the EHR certainly presented challenges, but physicians were determined to have a way to interact with the system. In the beginning, the additional information had to be adapted and deleted. “And that required that [for] some regimes, they had to differentiate themselves, and we had to build new ones. But I think it was a useful exercise because everyone needed consensus, discussion and agreement around that direction. “

The final step was to make sure the pathways were multidisciplinary – that doctors could work with a system that would allow transparency between medicine and radiation oncology so that treatment options could be presented together to patients. “What worked for us was that the system allowed that data transfer,” so if a decision was made in medical oncology, it was shared with radiation oncology.

“It was a huge thing in terms of the workflow, because we really had to be prepared that not only would the individual clinician be able to manage the workflow, but then you sort of get to the next level where it is: “What about the multidisciplinary workflow?” ? ‘”he said.” You have to simplify it for these things to happen. “

The next step is to use new data on the course system by enabling artificial intelligence to use predictive analytics to inform decision makers in practice.

“It doesn’t really end there,” he said. More value will come from the investments that healthcare systems make in predictive analytics.

“We have started to bring our decision data on clinical pathways to the discrete elements that flow from that decision. We started to integrate this into data tables and link it to our clinical information to better understand when decisions were made and what happens after that. This allows clinicians to decide what care plans should look like and how much monitoring should be done.

Geisinger also chose to include prognostic questions. As difficult as it may be, doctors are asked if they would be surprised if the patient died the following year. The response helps increase the number of referrals to palliative care.

The healthcare system realizes that it is asking physicians to take the time to collect data and add clicks to their day, Wojtowicz said. Adoption rates have been good and the process continues to improve.

From the point of view of the health system, “they extract data in a discrete manner and merge [the data] with some of our clinical data to get the most out of it.


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