Doctors’ visits these days usually involve staff entering notes about your care into a computer, but what you may not know is your “electronic health record” – or EHR – can do more than store facts. It may one day keep you out of the hospital.
Mercy researchers studied whether the data from cancer patients’ previous visits could predict when symptoms like nausea, vomiting and pain would send them to the emergency room (ER) for additional care. The results were remarkable enough to win a 2020 Innovator Award from the Association of Community Cancer Centers.
“The ACCC Innovator Awards honor a select group of cancer programs that have created forward-thinking, replicable solutions to enhancing quality cancer care,” said Dr. Randall A. Oyer, M.D., president of the ACCC. “Mercy developed a cutting-edge, detailed algorithm, which succeeds in reducing hospital admissions and emergency room visits.”
The key was the data stored inside all those electronic health records.
“Mercy is uniquely positioned because we have 12 years of inpatient and outpatient records in our EHR,” said Dr. Jay Carlson, director of Mercy Cancer Care Performance Acceleration. “We looked at a three-year window of patients who were taking chemotherapy for cancer – about 8,300 patients with more than 90,000 chemotherapy encounters. We then analyzed the data for risk factors that would drive them to the ER or a hospital admission.”
That knowledge led to immediate changes in patient care.
“One of our patients who showed up on the high-risk list was there because of persistent nausea and vomiting,” said Deb Essary, Mercy hematology and oncology nurse practitioner. “She had frequent emergency admissions and also had a couple of hospital admissions. So, we talked about it. We found out it was a lot of anticipatory nausea and changed her regimen. We sent her for IV fluids frequently during that week and the next.”
The list of high-risk patients goes to Mercy’s cancer clinics and infusion centers across a four-state area each day. “A patient may have been low risk during the last chemotherapy encounter, but high risk this time,” Dr. Carlson said. “There are multiple data points that go into the record today, such as pain score or performance scale, that runs through the algorithm tonight and update a new prediction for each patient. It’s called real-world evidence, and the concept is that today’s data literally changes tomorrow’s care.”
While the predictions are helping patients feel better, they’re also helping to keep health care costs lower for everyone. The Centers for Medicare & Medicaid Services is monitoring to see which health care providers’ cancer patients are frequently readmitted for side effects, which racks up additional bills. Mercy is voluntarily participating in the central reporting.
“CMS is measuring this and looking for benchmarks,” said Michelle Smith, director of Mercy Oncology Services in the St. Louis area. “Right now, it’s a self-reporting process. I think as we proactively address this and are ahead of the curve by looking at our risk assessment, we’re going to have better benchmark scores and better patient outcomes.”
As for the patient with the debilitating nausea: “I called her a couple of days later and the nausea had completely resolved,” Essary said. “We’ve been able to keep her on chemotherapy and she hasn’t had any additional admissions.”