Developing a Cardio-Oncology Registry for EHR Integration

Developing a cardio-oncology registry for EHR integration could help close care gaps, permit future clinical research projects, and improve the cardio-oncology specialty at a quicker rate, according to a study published in JMIR Publications.   

Cardiovascular care is critical for cancer patients, but healthcare professionals said it is not clear how effectively the cancer survivor population is typically screened and treated for cardiomyopathy. With EHR adoption now widespread, researchers aimed to evaluate the potential of an EHR-integrated cardio-oncology registry that could address care gaps in cancer patient cardiovascular care.

Due to past treatments, it is common for cancer patients to have hypertension, dyslipidemia, and insulin resistance. It is also common to have overt cardiovascular diseases, including coronary artery disease, left ventricular dysfunction (LVD), and heart failure with reduced left ventricular ejection fraction (HFrEF). Cardio-oncology is now an important specialty to provide cardiovascular care to cancer patients, the study authors explained. 

Researchers developed a deidentified, real-time EHR-integrated cardio-oncology registry from cancer-diagnosed patients at the University of Texas Southwestern Health System. The research team evaluated left ventricular ejection fraction (LVEF) assessment before and after treatment with guideline-directed medical therapy (GDMT) for LVD and HFrEF.

Research revealed a care gap in adherence to guidelines for baseline ejection fraction assessment. Additionally, the data showed post-chemotherapy cardiac dysfunction to be a relatively rare event. It also identified a second care gap in prescribing guideline-directed medications for patients with post-treatment cardiomyopathy.

Furthermore, the study showed that rapid development and integration of a cardio-oncology registry is possible and it can quickly identify relevant outcomes that are similar to manual chart abstraction, the study authors wrote.

“Clinical guidelines in this field are relatively new, creating opportunities for identifying and closing care gaps through population health–based approaches, with the goal of enhancing patients’ long-term outcomes,” study authors explained. “Pragmatic registries using EHR data collected as a byproduct of clinical care would prove more practical than manual chart abstraction for scaling to meet local and national needs.” 

Developing an EHR-integrated cardio-oncology registry to identify care gaps could improve cardiotoxicity surveillance timelines. 

An EHR-integrated cardio-oncology registry could also provide key data on the nearby oncology patient population as a result of routine clinical care. 

“Overall, incidences of LVD and HFrEF postcancer treatment were low (9.4% and 2.5%, respectively),” the study authors wrote. “Of note, patients receiving anthracyclines and HER2 antibodies had a lower incidence of LVD when compared with that of patients receiving other types of chemotherapy. This difference likely reflects selection bias and relative underscreening of the population exposed to chemotherapy classes not traditionally viewed as cardiotoxic.”

Furthermore, leveraging EHR data can be worthwhile and useful for future research. Health IT professionals can develop EHR data-based registries in months or even weeks. 

“As above, adopting standard terminologies (mapping local EHR codes to standard codes) greatly facilitates combining data from multiple sites,” the study authors wrote. “Additionally, the use of standard Health Level Seven International Fast Healthcare Interoperability Resources (FHIR) now enables communication of data between EHRs and a common registry database.”

For example, the researchers utilized FHIR to integrate data from the EHR system into the study database. Meaning, it is possible to create a nationwide or international cardio-oncology registry database by receiving patient data from multiple sites using FHIR EHR connections, the study authors explained. This potential structure would streamline EHR data from multiple EHR platforms and sites.

“As a byproduct of clinical care, EHR data can efficiently populate a real-time pragmatic registry of cardio-oncology patients with data enabling pragmatic comparative effectiveness research,” the study authors concluded.