Ordering and administering chemotherapy are foundational to the practice of oncology and comprise the most common, and the highest risk, workflows at community oncology practices. As creators of software at the intersection of technology and cancer care, our responsibility is to build safe and intuitive tools to support each step in the care delivery process — and to act quickly and creatively when improvements are needed.
The Safety Assurance Factors for EHR Resilience (SAFER) guidelines published by the Office of the National Coordinator for Health Information Technology (ONC) identify areas of healthcare IT that pose the highest patient safety risk, and offer suggestions to help mitigate those risks. These guidelines provide helpful recommendations. But the clinicians who use healthcare IT software as they treat patients every day add another crucial level of insight.
When clinicians in our network told us they wanted to avoid cumbersome and counterintuitive steps when trying to ensure that a dose of chemotherapy is safe and appropriate to administer to a patient, we investigated and learned that this is a surprisingly common issue cited by users of multiple oncology EHRs.
By way of example, two pharmacists in one of our partner practices said that, in attempting to verify the calculation of a carboplatin dose, it took them several minutes and at least a dozen clicks to finally confirm the dose. Such a counterintuitive workflow that requires users to bounce around to different pages in an EHR can decrease productivity and potentially increase the risk of human error.
This valuable user feedback led to the Dose Calculation (patent pending) redesign project, a collaboration among our product managers, software engineers, designers, clinicians and patient safety experts. This type of cross-functionality is central to the work of Flatiron’s Patient Safety Program, which is responsible for identifying high risk areas and developing tools to facilitate safe patient care. The project team identified key problem areas and solutions to produce a more transparent and user-friendly design, including:
- a simpler, more intuitive Dose Calculation workflow;
- an improved warning system that alerts a user at the point of care when a patient’s weight has changed enough to impact their prescribed medication dose;
- a more consistent dose-adjustment system with fields to show when, and by whom, a dose was last updated, and a more prominent “reason” field to facilitate communication across the practice about why a dose was changed, and
- a new set of “badges,” visual alerts that provide additional clarity about the variables used in the Cockroft-Gault and Calvert formulas for calculating carboplatin doses, including the minimum serum creatinine and maximum creatinine clearance values.
With these design changes, it takes moments instead of minutes and half as many clicks for a clinician to confirm that a dose of chemotherapy is safe and appropriate.
Given the high risks being addressed, we followed up our extensive internal testing with two additional steps before handing it over to practices for everyday use. First, we implemented an internal monitoring system that alerts Flatiron to any potential issues before they might become disruptive to EHR users. And second, our design team conducted multiple rounds of Safety Enhanced Design testing with clinicians across our OncoEMR® network to ensure that the major functions of the redesigned workflow are intuitive and easy to learn.
The responsibility and privilege of ordering potentially life-saving – yet highly-toxic – chemotherapy is unique to oncology. The safe delivery of chemo depends on skilled doctors and clinicians maintaining a safety-first mindset supported by clear, intuitive point-of-care software. Our redesigned Dose Calculation workflow is now in use at several practices, and the feedback has been very positive.
“The new Dose Calculation workflow is easier and more user friendly,” said Brian Freeman, MD, a doctor at OncoEMR® practice Mission Cancer + Blood. “The whole process is more logical and flows in the way that an oncologist’s brain works and thinks.”