Using Data-driven Clinical Decision Support to Integrate Precision Cancer Symptom Management Into the Electronic Health Record.

OBJECTIVES: Electronic patient-reported outcome measures (ePROs) are being implemented in clinical care to monitor symptoms in patients with cancer. Although the use of these measures is associated with improved outcomes, challenges remain with integrating ePROs into the workflow due to burdensome training and unclear roles for who will manage uncontrolled symptoms. The use of clinical decision support (CDS) can mitigate these challenges. This article discusses the use of CDS, the integration of CDS into the electronic health record (EHR), lessons learned, and future directions. METHODS: The Sapphire Cancer Symptom Management CDS system is used to illustrate the development, integration, and testing of CDS in the EHR. A team of experts designed this system based on previous experience and research literature. The discussion synthesizes peer-reviewed literature, expert opinion, systematic reviews, and meta-analysis as sources of data. RESULTS: Symptom management algorithms were created for nine cancer symptoms and then programmed into the CDS platform and integrated into the EHR. Integration involved using innovative technologies, which included application programming interfaces and interoperable data standards, to integrate the system into the EHR. Relevant EHR and patient-reported data were used to generate individually tailored symptom management recommendations. Testing of the system was accomplished using test patients that reflected real-world patient experiences. We found that the data needed for the algorithms were complex and some elements were not readily available in the EHR. Having clinicians verify a few critical elements assured accuracy and safety of the recommendations. CONCLUSION: Innovative technologies enabled the integration of CDS into the EHR and the generation of individually tailored cancer symptom management recommendations. Future testing is needed to evaluate whether the use of CDS improves patient outcomes. IMPLICATIONS FOR NURSING PRACTICE: CDS has the potential to improve guideline-concordant symptom management and facilitate supportive care referrals at the point-of-care to improve clinical care.

Duke Scholars

Author David Franklin Lobach Family Medicine and Community Health