- Dartmouth-Hitchcock Medical Center (DHMC) is one of six health systems sharing a $9 million grant from the National Institutes of Health (NIH) to leverage Epic EHR for research into improving cancer care.
NIH and the Beau Biden Cancer Moonshot initiative will fund the consortium — called the SIMPRO Research Center — as part of an effort to integrate the use of electronic patient-reported outcomes (ePROs) into oncology for improved symptom management and decreased hospitalizations.
DHMC Chair of Surgery Sandra Wong, MD, serves as a co-principal investigator on the initiative and leads the DHMC team. The health system’s CHIO Peter Solberg, MD, and NCCC medical oncologist Gabriel Brooks, MD, will also serve as co-investigators.
“Post-operative symptom management is an underutilized strategy for improving surgical care,” said Wong. “This work will help us understand how surgeons should implement ePROs especially for patients who travel great distances for their operations.”
Boston-based Dana-Farber/Brigham and Women’s Cancer Center, Baptist Memorial Medical Center in Memphis, Lifespan Cancer Institute in Rhode Island, West Virginia University Cancer Institute, and Maine Medical Center in Portland, ME comprise the other five health systems part of the project.
The consortium of six health systems will work with Epic EHR to complete the research project. All participating institutions utilize an Epic system to deliver patient care.
“Integration of patient-reported outcomes is at the heart of our patient-centered care philosophy,” said NCCC Director Steven Leach, MD.
“As the only NCI-designated comprehensive cancer center located outside of a major urban center, NCCC can play a leading role in delivering care to rural populations,” Leach continued. “SIMPRO will help us to improve outcomes and experience for those rural patients.”
Physicians and researchers part of the SIMPRO Research Center will develop, implement, and evaluate an ePRO reporting and management system through an app called eSyM.Patients. Smart devices will enable a secure connection to SIMPRO’s cancer care team through Epic EHR.
The connection will facilitate symptom tracking after patients receive cancer surgery or chemotherapy. As part of the study, researchers will test whether monitoring patients’ symptoms and offering coaching for symptoms management will lead to decreases in hospitalizations and emergency department (ED) visits.
“Engaging patients to report their symptoms between clinic visits gives us a chance to intervene sooner when new symptoms or treatment-related side effects arise,” said Brooks. “And we hope that early intervention will translate to better outcomes for patients.”
eSyM will be integrated directly into Epic EHR systems at each participating health system following development and pilot testing. By integrating the app into provider EHRs, users will have the opportunity to more easily communicate and provide real-time updates to clinicians. Clinicians will also have access to a dashboard of patient’s symptoms to prioritize outreach efforts and coaching.
“The opportunity to partner directly with Epic and their resources, to build these tools into our electronic health record, means in the short-term the research is more likely to bear fruit,” said Solberg. “In the long-term that successful strategies can be disseminated around the country.”
SIMPRO investigators will conduct a randomized trial to evaluation eSyM implementation from the perspectives of patients, clinicians, and health systems.
Researchers will also evaluate the implementation, adoption, acceptance, and adaptation of the ePRO system at each study phase to ensure the health IT tools are meeting the needs of cancer patients.
DHMC recently went live with 2018 updates to its Epic EHR system as part of an EHR optimization project.
The health system bulked up its IT support in anticipation of the changes and implemented a new IT service management platform to ensure clinicians and administrators had the specialty support necessary to navigate the more than 20 applications built into the system.
The DHMC IT team has leveraged the IT services dashboard to address trouble tickets and make changes in accordance with provider feedback in a streamlined way.