Implementation of electronic chemotherapy ordering: an opportunity to improve evidence-based oncology care

From Clinfowiki
Jump to: navigation, search


Evidence based medicine is an important part of Clinical Decision Support and Electronic Health Records. In recent years the approach to implement Evidence based medicine has been a slow progress. There is known to be little adherence of providers to follow evidence based medical protocol guidelines in the treatment of many diseases including cancer. In this study done by Adelson et al, (2014) [1] an opportunity to implement medical guidelines for cancer treatment through the National Comprehensive Cancer Network is designed. According to the author there is approximately 60% of providers who adhere to medical guidelines. Barriers such as hand written notes difficult to read and improper documentation in the patient's chart are valuable reasons that has guided modern medicine to practice good clinical guidelines. Therefore, the purpose of this study is to improve health care and increase the implementation and use of "Evidence based chemotherapy regimens" to reduce medical errors, improve patient safety, improve practice efficiency by using a novel quality metric that could measure adherence of EBM. [1]


The implementation of EBM with focus on chemotherapy regimens was designed to be integrated into the Electronic Health Records where a transition to Epic Beacon electronic chemotherapy ordering platform was performed. The planning began 2 years prior to the implentation by a council committee responsible for approving regimens for cancer treatment. The study used various methods to reach the intended purpose.

  • Assessment of readiness to ensure proper infrastructure and resources.
  • Creation of EBM Chemotherapy Library
  • Development of Nursing Flowchart with appropriate safety checklist and documentation
  • Creation of the Quality Metric that rates the number of times the protocols were used (Rate of Evidence-Based Adherence, REBA)


The efficiency was measured through REBA with a 86% adherence to the evidence based chemotherapy regimes. Patient safety was not an issue in this study, all medication regimen were scanned with nearly zero in errors. Antiemetics were administered in a greater percentage due to the increase in adherence to protocols as well as other supportive care medications. "The results show increasing user acceptance over time." [1]


The implementation of Evidence based medicine is a great opportunity to improve overall health care and oncology treatment. The integration of EBM in the Electronic Health Records has proven to be satisfactory to health institutions and clinicians. In this study by Adelson et al, (2014) [1] it was concluded that the transition of the Epic's Beacon implementation was one of the most successful among those prior to it. Improved efficiency, patient safety, and the ability to monitor the rate of adherence (REBA) demonstrates the overall success. Key elements that contributed to the success were excellent oncology leadership, the committee for chemotherapy council, clinician validation of protocols, and the collaboration between HIT and clinical operations. [1]


Evidence based medicine is a pathway to reducing medical errors. The integration of EBM in the Electronic Health Records is essential in addition to CDSS and CPOE. Every one of them are interrelated and should be a tool used in every health institution.

Related Articles

Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System


  1. 1.0 1.1 1.2 1.3 1.4 Editing Implementation of electronic chemotherapy ordering: an opportunity to improve evidence-based oncology care,,Adelson, K. B., Qiu, Y. C., Evangelista, M., Spencer-Cisek, P., Whipple, C., & Holcombe, R. F. (2014)