Cancer Center Networks Lack Care Coordination, EHR Interoperability

Academic cancer centers and their extended network sites often lack access to complete EHR data, according to a study published in the official journal of the National Comprehensive Cancer Network (JNCCN) that raises care coordination and interoperability concerns.

The study’s results are based on a mixed-methods survey conducted between September 2017 and December 2018. Researchers collected data from 56 cancer centers with at least one network practice site.

Respondents reported that 57 percent of networks had complete, integrated access to their main center’s EMRs. Five respondents reported no access between networks and the main center.

On the other hand, only 50 percent of main centers had full EHR access to their entire network of care sites. Six main centers reported that they had no EHR access to network sites.

Without access to complete patient health data, providers do not have the necessary information they need to make informed clinical decisions. Patients may also miss out on participation in clinical trials due to a lack of interoperability, Stanton L. Gerson, MD, the study's lead researcher, said in a press release.

"Our findings demonstrate the need to improve network site alignment,” Gerson noted. “Greater cancer center/network coordination could ultimately lead to improved access to clinical trials for the underrepresented communities many of these network sites serve."

The survey asked respondents to describe the various interoperability challenges and solutions between main cancer centers and network practice sites.

Of 28 respondents, 75 percent indicated that main cancer centers and network sites leveraged different EHR systems.

While the survey revealed a lack of interoperability in cancer care, it also pointed out a silver lining; many cancer centers are actively working towards more streamlined patient data exchange between network sites and the main site.  

Half of respondents indicated that their centers were working toward network-wide Epic cloud computing-based EHR implementations, providing the potential for care coordination improvement.

Survey respondents also noted that hiring chief information officers to act as liaisons between sites for improved data exchange, communication, staff training, and interfaces was a useful solution in improving interoperability.

"Many studies show that consistency through care plans and guidelines improves patient outcomes, clinical response, and survival,” Gerson, who currently serves as interim dean of the Case Western Reserve University School of Medicine, explained.

“More proactive approaches, including care paths, tumor boards across networks, and recognition of the value of placing disease experts at network sites, will improve the standardization of care across sites,” Gerson added.

Care coordination remains an issue between many kinds of healthcare centers and care sites, not just academic cancer centers. The Veterans Health Administration (VHA) has experienced similar interoperability difficulties.

VHA leverages non-VA healthcare providers in the community to help provide veterans with timely access to care. Often, these non-VA providers leverage a different EHR system than the VA.

After a veteran receives care at a non-VA facility, VHA employees must update the veteran’s EHR with documentation from that visit so VHA physicians have access to the patient’s full medical history. This manual transcription process can lead to clinical documentation errors.

According to a recent OIG audit, community care staff at VHA facilities made errors in 44 percent of cases reviewed when indexing veterans’ mental health medical records into their EHRs (108 errors identified for 92 of 209 veterans). These errors included ambiguous or incorrect document titles, duplicate records, and records indexed to the wrong non-VA care referral or veteran.