title: Implementation of electronic chemotherapy ordering: an opportunity to improve evidence-based oncology care.
abstract: OBJECTIVE
  The degree to which electronic health records (EHRs) enhance the quality of patient care depends on use of the system to monitor and improve practice. In planning the transition to Epic's Beacon electronic chemotherapy ordering platform, we saw an opportunity to measure our performance and increase evidence-based practice.
  
  
  METHODS
  Advanced planning began 2 years before implementation and included formation of a chemotherapy council charged with reviewing references and approving each chemotherapy protocol; a readiness assessment; design of electronic flow-sheet adherent with Oncology Nursing Society guidelines. To monitor use of evidence-based treatments, we created a novel quality metric: the rate of evidence-based adherence (REBA).
  
  
  RESULTS
  A full infusion schedule was maintained through implementation, with a transient 1-month increase in wait time. Our overall REBA of 0.86 significantly exceeded our prespecified goal of 0.80 (P = .001). REBA varied from 0.50 to 0.95 between disease groups. Antiemetic use increased by 20% after Beacon implementation. Provider satisfaction at 8 months ranged from 76% to 80%.
  
  
  CONCLUSIONS
  The transition to electronic chemotherapy ordering offers an institution the chance to develop evidence-based oncology practice, standardize supportive care, and enhance patient safety. The key elements that made our transition so successful were (1) extensive involvement of oncology leadership, (2) use of a chemotherapy council to enforce evidence-based practice, (3) ongoing collaboration between clinical operations and information technology. Finally, the REBA is a powerful tool to monitor adherence to evidence-based chemotherapy prescribing.
authors.affiliation: The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY.
authors.forename: Kerin B
authors.initials: KB
authors.lastname: Adelson
authors.forename: Ying Chun
authors.initials: YC
authors.lastname: Qiu
authors.forename: Michelle
authors.initials: M
authors.lastname: Evangelista
authors.forename: Patricia
authors.initials: P
authors.lastname: Spencer-Cisek
authors.forename: Clare
authors.initials: C
authors.lastname: Whipple
authors.forename: Randall F
authors.initials: RF
authors.lastname: Holcombe
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000592:standards*; D057286:Electronic Health Records; D055317:Evidence-Based Practice / Q000592:standards; D006282:Health Personnel; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D050316:Medical Order Entry Systems; D055118:Medication Adherence; D009369:Neoplasms / Q000188:drug therapy; D009859:Oncology Nursing; D061214:Patient Safety; D058996:Quality Improvement
chemical_list: D000970:Antineoplastic Agents