Vol. 18 •Issue 17 • Page 13
Informatics and the Cancer Registry
Registrars report positive experiences with EMRs.
Cancer registrars across the U.S. and Canada are experiencing revolutionary change caused by new features of the electronic medical record (EMR).
To better understand how informatics has impacted the registry environment, hospital registrars across the country and Canada were informally polled. In general, for those who have transitioned to electronic records, registrars report positive experiences, and report that their efforts are faster, more complete and accurate, with less stress.
Registrars report a tremendous variety among completeness and content of EMR systems. Some are inferior to paper records, are not easily navigated and are very slow. On the other hand, some EMR systems are extremely efficient and complete. In some cases a dual screen system is utilized.
Case finding has changed, too. For example, some systems provide automatic case alerts from hematology and oncology, and an ability to better identify class 3 cases. In some instances patients are identified that were not reported by pathology. Some report that staffing time for case finding is cut in half. Some sites have direct downloads of demographic data from the EMR to the registry application.
The primary activity of abstracting has also shifted significantly. The charts are immediately available, and can be more complete and accurate while improving legibility. Charts don’t have to be shared or waited for. In some cases time is saved in finding the basic demographic information. The tedium of looking up phone numbers, addresses and Social Security numbers is simplified. For some EMRs the charts have the same look and feel so as to make using them much quicker. Keystrokes are sometimes limited for the abstractor to find necessary information, with copy and paste features available. The chart can be better organized, the information summarized, with treatment plans standardized.
Other advantages reported were finding latest prescriptions received, latest appointments kept and any new lab results. Some EMRs provide machine-assisted legibility, limiting the effect of difficult handwritten notes. Multiple users can be reviewing the chart simultaneously. Some EMRs allow tracking outside consults and treatment summaries that are attached to the existing consults, as well as pharmacy visits. EMRs tend to promote standardized terminology for treatment plan templates and other records.
Registrars report that the EMR enhances quality of the data. The registrar can concentrate on abstracting standards. Further, timeliness and being concurrent with the medical process increases physician and administrative interest in the registry.
Some hospitals have developed “TNM Staging Forms” that meet the CoC standards. The staging form is standardized and universally available for easy medical reference. The physician can point and click to complete the staging process.
Registrars report the majority of the actual follow-up work is done by accessing the facility EMR, which can provide real-time status. This can serve to improve the follow-up rate, as well as staff morale. This work can also be done from home.
Some limitations or disadvantages were noted. It can get cumbersome finding and reviewing multiple areas for information. Some EMRs still in transition require that the user access different databases to complete the abstracting process.
Herman R. Menck is a project manager with the Los Angeles Cancer Surveillance Program.