ASH Clinical News ACN_4.5_FULL_ISSUE_DIGITAL - Page 38

Electronic Health Records Meaningful Use Success Stories Roadmaps, clinical decision support, big data analysis – these are some areas where EHRs shine brightest. Here is just a sampling of some EHR success stories in hematology: • Researchers at the Children’s Hos- pital of Wisconsin developed a computable phenotype algorithm to identify patients with sickle cell disease through EHR data. The algorithm was validated in adults from a neighboring health system and was deemed to have reliably high sensitivity and positive pre- dictive value for its intended use. The authors eventually hope to use their method to conduct research at the national level. 1 • Providers were able to reduce un- necessary blood transfusions (a well-recognized source of medical overuse) by embedding decision support within an EHR-based transfusion order set. 2 • At Washington University in St. Louis, Missouri, a team in the medi- cal school’s Pediatric Computing Facility is developing the electronic Oncology Roadmap Application. This program will allow for seam- less sharing of comprehensive “treatment roadmaps” built in to EHRs and based on the Children’s Oncology Group protocols. The same technology can be applied to adults. 3 • Recognizing that the data collected by randomized clinical trials (RCTs) are often similar to those found in EHRs, a group in the Netherlands merged a population-based registry with an advanced EHR system to generate high-quality data for ob- servational studies in hematology/ oncology. The approach may bridge the gap between the RCT world and the real world. 4 REFERENCES 1. Michalik DE, Taylor BW, Panepinto JA. Identification and validation of a sickle cell disease cohort within electronic health records. Acad Pediatr. 2017;17:283-7. 2. Sadana D, Pratzer A, Scher LJ, et al. Promoting high-value practice by reducing unnecessary transfusions with a patient blood management program. JAMA Intern Med. 2018;178:116-22. 3. Washington University in St. Louis School of Medicine, “Pediatric Hematology-Oncology Roadmap Builder.” Accessed March 8, 2018, from http://pediatrics.wustl. edu/pcf/Projects/eroadmap. 4. Kibbelaar RE, Oortgiesen BE, van der Wal-Oost AM, et al. Bridging the gap between the randomized clinical trial world and the real world by combination of population- based registry and electronic health record data: a case study in haemato-oncology. Eur J Cancer. 2017;86:178-85. 36 ASH Clinical News clear mandate and ease-of-use were crucial factors in obtaining buy-in and compliance from the clinical staff.” They also noted that implementation of an EHR system is never done, and, even after established, the system required constant monitoring. 11 “The heart and soul of oncology is clinical trials, so systems that help us track studies and reduce costs and time involved in patient care are valuable,” said Dr. Zelenetz. His group is working on an easy way to record drug-related adverse events for use in clinical investigations. The Interoperability Problem Clearly, collecting EHR data has great implications for patient care and medical research, but EHR systems need to be able to “talk to each other” if any of those goals are going to be realized. “We have been behind in medicine in creating a standard for exchanging medical information,” said Dr. Zelenetz. He suggested this is as much a result of vendor competition as it is a technical issue. Health-care IT has borrowed the term “interoperability” from the systems engineering world to describe the ability of EHR technology and software applica- tions “to work together within and across organizational boundaries in order to advance the effective delivery of health care for individuals and communities.” 12