Telehealth, properly integrated with EHRs, can boost cancer care
Cancer is a very complex disease, but technology should ideally make the care of cancer patients easier.
However, that is sometimes easier said than done. Kathy Dalton Ford, head of product and strategy at Ronin, which develops clinical oncology software, believes virtual care and other technologies can help providers improve their cancer care. But the tools need to be properly calibrated.
Healthcare IT news spoke with Ford to discuss what it is about cancer care that lends itself well to telemedicine, how integrating electronically reported outcomes with the electronic health record is helping the entire virtual oncology effort, and much more.
Q. At Ronin you work to enable better cancer treatment through virtual care tools. What makes oncology so suitable for telemedicine?
A. Cancer is one of the few diseases where we have to make patients sicker to get better.
Telemedicine is best used in low-acuity situations – cases where it is not inconvenient to be on video or participate in a live video chat or discussion.
But if you’re feeling very nauseous, incredibly lethargic, tired, and suffering from various side effects, you may want to find a safe and reliable way to connect with your clinical team – but not necessarily in a synchronous way.
Thus, systems that provide reliable, asynchronous communication methods and relevant education are ideal for cancer patients. This way, patients can report side effects after treatment and ask their care teams if this is something they can expect.
Electronically reported outcomes are a natural complement to traditional telehealth and enhance home care by providing specificity and context to symptoms, allowing clinicians to take precise action. It may take a few minutes or hours to get an answer from the healthcare team, but it can be reassuring to get answers about the side effects they are experiencing – what they mean and the next steps for managing the reported symptoms.
“Having these types of tools built into physicians’ workflow by integrating them into the EHR is another level of convenience that is increasingly at stake at this stage.”
Kathy Dalton Ford, Ronin
Meanwhile, this form of communication gives the clinical team a way to review and view the patient’s complete history. This allows the clinical team to prioritize patients with higher severity levels, which will help them avoid side effects and reduce unnecessary emergency department visits.
Q. What elements of cancer care can doctors and nurses address during their cancer care journey with telemedicine?
A. Telemedicine is viewed as a synchronous connection with an agreed upon time when two parties meet, versus an asynchronous communication system where the healthcare team and patient do not need to be available to communicate at the same time.
Suppose your nurse or doctor is with another patient. In that case, they can treat that patient and be in the moment – as you would want them to be with you – and then immediately respond to the messages that come in virtually based on severity.
The portal is the other alternative. While a portal is asynchronous, it is also incredibly inefficient; it often acts as a collection point for patient questions. It must be filtered, allocated, sorted and distributed, which often places a greater burden on a clinician.
These tools are intended to minimize the burden on physicians, reduce time spent in the EHR, and respond to patients after hours. Electronically reported results provide simple, efficient and contextualized treatment-specific information in an asynchronous, direct and secure manner – back and forth with the patient – serving the healthcare team and the patient much more effectively.
Q. How can integrating electronically reported outcomes with the electronic health record help the entire virtual care effort for cancer care?
A. Integration is critical because no doctor wants to log into separate applications or use an insecure, non-HIPAA compliant tool like FaceTime, Zoom, or anything else on their phone. They definitely want to keep their personal phone number private.
So building these types of tools into physicians’ workflow, by integrating them into the EHR, is another level of convenience that is increasingly on the cards at this stage.
It is essential that patient-reported symptoms are automatically written back from the electronically reported patient app to the EHR. No intervention from the clinical team should be required.
Q. In October 2022, Providence St. John’s Health System implemented your company’s multi-phase cancer information platform. How were the electronically reported outcome components of this implementation created?
A. Whether it is Providence or one of our clients, the ability to stay connected to a patient throughout treatment and to manage expectations and fears as they navigate this extremely complex disease and treatment journey has been paramount for their patient population.
Depending on what is happening with the patient, the information provided by the electronically reported outcomes system may allow physicians to prevent adverse events, avoid unnecessary office visits, or give the patient clear instructions to go to the emergency department due to the reported symptoms.
Thus, the ability to intervene quickly and do so easily for the physician and patient is essential for patient safety, outcomes, and satisfaction.
And when you consider the geographic location of St.
John’s in Santa Monica, Southern California, traffic can be a real hurdle. If you live 20 miles from St. John’s, the commute to the hospital can easily be 90 minutes. It is an incredible gift and enhanced patient experience to offer an application that is easy to use and can prevent unnecessary trips.
Communication between patient and doctor is crucial during this process. The application guides the patient in documenting all information relevant to clinical decision making and opens the door for productive communication.
Providers can ask additional questions and send educational materials based on the patient’s answers. It is highly personalized for each patient and their situation, so that he or she feels connected and heard. Again, the design of these tools can help prevent avoidable trips to the emergency department, manage patient expectations, and ensure physicians have the real-time data to make confident and informed clinical decisions to improve patient outcomes to improve.
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