We spoke with Carmen and Manda about a typical day in the practice, their experience with the new Drug Substitution feature and more.
Joining us today From the Community, we’re speaking with Carmen Jacobson, BSN, RN, Sr. Director of Clinical & Business Informatics at CARTI, and Manda Wood, Clinical Analyst at CARTI.
Flatiron: Carmen and Amanda, thank you so much for speaking with us today! Before you share your experience with us about the new Drug Substitution feature, can you tell us a bit about how you would describe a typical day for you in the practice?
Carmen: Well, we’re constantly building new order sets, regimens…
Manda: I think about half of it's, like, reactive, you know? People will call us and say, “hey, we can't do this” or “how do we do this?” so we address things like that. And the other half of the day is maintaining the flow of things and making sure that we’ve got the best workflows going.
Carmen: That's kind of our goal, to get to that point where we're more predictive and can improve on things instead of just reacting to tickets.
Flatiron: Absolutely. In all of the Flatiron Communities interviews I’ve done, that theme of being reactive is something that resonates with a lot of people.
To focus on some questions around the new drug substitution feature, I’m curious what your experience was like managing drug substitutions at CARTI prior to this new OncoEMR® feature being released.
Carmen: Luckily we didn't have to manage drug substitutions for very long before the new feature. But what we did is we had every regimen that had, you know, like say bevacizumab in it - every version of bevacizumab that we used here, and they're ordered just the same. They had prepared us a dashboard that had payer preferences by drug, that would tell you, hey, Aetna prefers this biosimilar, Humana prefers this biosimilar. And so the clinical staff was supposed to look at this dashboard when they're going to prescribe a regimen for their patient. And then they would uncheck the boxes of the bevacizumab biosimilars that weren't the right one.
As you can imagine, that’s not ideal. A lot of them didn't do it, for several reasons. One was, they would try to just remember what the payers wanted. But even if they did that effectively, the payers change their minds constantly. Sometimes the nurse ordered it right to begin with but then the payer changed their mind. The only process to change that out was to go in and order another regimen with the same drug and steal from it. And so it was very time consuming. The clinicians hated doing it.
The process to change that out was to go in and order another regimen with the same drug and steal from it. And so it was very time consuming. They hated doing it.
Flatiron: So when this new drug substitution feature came out in OncoEMR®, how was the adoption of it? Were there any surprises or trouble you had adopting the new feature?
Carmen: It was easier to convert [to using this new feature] than I thought it would be. I forget how many regimens we had to do. But, to avoid doing the regiment conversion while patients were being seen, I did the conversion over a weekend. I did it on a Sunday afternoon when I knew that the least amount of providers would be in ordering regimens.
And it really didn't take as long as I thought it would. We delayed it! We procrastinated on it just because of the sheer volume of what we were gonna have to go in and change. But our Account Manager, Spencer, got me in touch with someone who was able to walk me through what they thought we should do. So I made a copy of every regimen and took out the extra drugs, kept them in a copy status and then, demoted the other ones and promoted them all on a Sunday. And I was able to do it all in one day.
So I made a copy of every regimen and took out the extra drugs, kept them in a copy status and then, demoted the other ones and promoted them all on a Sunday. And I was able to do it all in one day.
Flatiron: Once you adopted the new drug substitution feature, what would you say the experience using it has been like for the practice?
Carmen: I'm gonna say on that Monday, I probably got two or three texts from nurses saying “this is freaking amazing.”
Flatiron: Oh! That’s incredible.
Carmen: They liked that they didn't have to think about it. It's funny because now whenever something has changed, like a payer has changed their mind or maybe we got it wrong in there when we set the preferences by payer, we get it pretty quick because as soon as it gets ordered and then it hits pre-cert, the nurse isn't picking the wrong one. She's picking the one the system tells her to pick.
Flatiron: It’s great to hear that CARTI is experiencing that benefit. Is there any other value of the new feature when you think about it? Something we’ve been working on this year is focusing on releasing features that help save clinicians time.
Carmen: The biggest value is mainly the time saving and just the coordination - that everyone's on the same page. It's accurate. It's consistent. It's upfront. So there are no teams having to do double the work.
Everyone's on the same page. It's accurate. It's consistent. It's upfront. There are no teams having to do double the work.
Carmen: The biggest deal for the nurses, the part that they liked the most, other than not having to go in and unclick the drug and reference the dashboard, which was huge, is that when they do get that call that they've gotta swap a drug out because the patient's struggling financially and we've gotten them approved for something, it's an order set. They go in, they swap out the drug, it's no big deal. Like it's easy peasy. They're happy about it.
Flatiron: That’s fantastic to hear. Thank you both so much for speaking with us and sharing your experience on Flatiron Communities. We so appreciate the chance to hear your perspective on your practice role and the new drug substitution feature!