title: Benefits of improving processes in cancer care with a care pathway-based electronic medical record.
abstract: OBJECTIVE
  We analyzed the intermediate and longer term changes in patients' waiting times following the implementation of an electronic medical record (EMR) dedicated to ambulatory treatment in both medical and radiation oncology.
  
  
  METHODS
  A pre-post study design was developed to assess improvements in patients' waiting times, defined as the number of days between key steps in patient management preceding the first treatment. The postperiod began 1 year after the EMR go-live to allow for a preliminary period of adjustment to the new EMR. The EMR under study was closely integrated into the clinicians' workflow, being designed as a care pathway information system to provide real-time support to the coordination of the entirety of care processes involving all the care personnel.
  
  
  RESULTS
  The large majority of the waiting-time indicators decreased over time, with decreases ranging from 2 to 28 days. However, an important time lag was necessary to see an improvement, to the extent that better access was only observed in the final months of the postperiod.
  
  
  CONCLUSIONS
  The study highlights the potential to design EMR applications that capitalize on tight workflow integration, both in medical and radiation oncology, to deal with the fundamentally collaborative nature of cancer care delivery.
authors.affiliation: Department of Health Administration, University of Montreal, Montreal, QC, Canada; Equipe Management des Organisations de Santé, Ecole des Hautes Études en Santé Publique, Rennes, France. Electronic address: Claude.Sicotte@umontreal.ca.
authors.forename: Claude
authors.initials: C
authors.lastname: Sicotte
authors.affiliation: Academic Healthcare Center, University of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lapointe
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Clavel
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
authors.forename: Marie-Andrée
authors.initials: MA
authors.lastname: Fortin
mesh_terms: D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities / Q000592:standards*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006284:Health Plan Implementation; D006751:Hospital Information Systems; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000628:therapy*; D010346:Patient Care Management; D018787:Radiation Oncology; D061665:Time-to-Treatment; D057188:Workflow