Information tools improve delivery of cancer services

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On average, 2,633 Canadians are diagnosed with cancer each week and 1,273 Canadians die as a result of the disease each week.

While these statistics support the critical need for investments in cancer services in general, they also suggest the specific need to develop information tools that enable delivery of safe and high quality care to cancer patients, and support evidence-based system planning and research for this devastating disease.

Responding to these needs, Cancer Care Ontario (CCO) – the provincial government’s primary adviser on all aspects of the cancer system – is working diligently with its health care partners to implement a number of strategic information management initiatives that will improve patient care.

One of these priority initiatives is the implementation of OPIS – a computerized physician order entry (CPOE) for systemic therapy across Ontario. Systemic therapy is made up of chemotherapy and non-chemotherapy drugs used to treat patients with cancer.

“OPIS is designed to enhance the quality and safety of cancer systemic therapy by using appropriate technology and information to assist clinicians in making the most appropriate decisions at the point of care,” says Dr. Brent Zanke, Provincial Head of Systemic Therapy at CCO and the Clinical Advisor to the CPOE project. “This is especially important in cancer care, given the high toxicity of chemotherapy drugs and potentially catastrophic consequences of errors in chemotherapy.”

Eight regional cancer centres are currently using CCO’s existing CPOE application, OPIS 2000. Physicians at these sites enter systemic therapy orders electronically, amounting to 38% of all systemic therapy orders in Ontario. While this is an unprecedented level of physician electronic order entry, CCO is striving for 100% usage across the province.

Feedback from doctors, pharmacists and nurses using OPIS 2000 has been overwhelmingly positive. This comes as no surprise because OPIS 2000 was originally developed with significant consultation and input from users.

In a recent survey of physician users of the system, 100% of respondents said the system has improved efficiency and they would be unwilling to practise without it. Pharmacists and nurses also strongly endorse OPIS. They benefit by having access to comprehensive, up to date information on orders and dosage changes, as well as treatment protocol and medication administration information.

Here are some other benefits users of CPOE can expect to gain:

Electronic prescribing systems intercept errors when they most commonly occur – at the time medications are ordered

Paper-based order entry and administration of chemotherapy drugs is labour intensive, with many hand-offs and opportunities for error

The practice of standardized, evidence-based chemotherapy across the province will be facilitated

Transcription errors will be eliminated due to difficulty interpreting handwriting

Timeliness of communication between physicians, nurses and pharmacists will be improved – for example, chemotherapy dosage adjustments will be communicated to all parties at the time they are made

Electronic prompts will warn against the possibility of drug interactions, allergies or overdose

CPOE will provide drug-specific information that eliminates confusion from drug names that sound alike

CPOE will reduce the need for multiple manual checks

A CPOE system also helps health system planners and researchers at CCO understand the rationale and patterns of systemic therapy practice and report on province-wide indicators of quality and access. It also significantly improves the electronic eligibility and reimbursement process for its New Drug Funding Program.

CCO’s CPOE project is divided into three manageable phases.

In Phase 1, OPIS 2000 will be upgraded to OPIS 2005 so that it can be integrated more easily into a hospital system environment, supporting better continuity of care for cancer patients. This enhanced version will be implemented in two or three new sites starting in winter 2004, increasing the proportion of orders entered electronically from 38% to nearly 50%.

In Phase 2, OPIS 2005 will be upgraded to a three-tier, web-based architecture, allowing for greater accessibility and broader application across the province. Called OPIS Web, this application will be implemented in 10 OPIS sites and six sites that currently do not have OPIS. This will increase electronic orders to approximately 64%.

In Phase 3, OPIS Web will be rolled out to approximately 15 new sites. This will increase electronic orders to 90% coverage.

“Implementing a CPOE system for systemic therapy drugs is an important initiative for Cancer Care Ontario, for hospitals across Ontario, for cancer patients and their families, and for the health system as a whole,” says Dr. Zanke.