Ordering chemotherapy within an Electronic medical record (EMR) can be a seamless process while working in a resource-rich setting. Implementing it in a under resourced setting can be challenging. Binaytara Foundation Cancer Center recently started using Karexpert EMR for inpatient and outpatient use. This was a major step in creating a paper-free experience at the hospital. However, Karexpert lacked the functionality to order chemotherapy within the EMR. The administration of chemotherapy is a complex process involving various stages, including drug protocol selection, dosage calculation, and schedule planning. The use of an electronic medical record (EMR) system facilitates the implementation of a chemotherapy order set and improve the safety and efficiency of the treatment process. We are documenting our experience of implementing chemotherapy order sets in Karexpert at Binaytara Foundation Cancer Center.
The mission at Binaytara Foundation Cancer Center is to provide world class oncological care in Janakpur, Nepal. To aid in accomplishing this mission Karexpert EMR was recently implemented at the hospital. It has been well received among the physicians at the hospital as shown by Dr. Shah and colleagues. Karexpert EMR lacks the ability to order chemotherapy electronically. We embarked on improving the EMR to include an electronic chemotherapy ordering process. We envisioned our EMR system to automatically calculate the dosage of drugs based on the patient factors such as height, weight, and age. This reduces the risk of errors that may occur when individually selecting drugs and manually calculating dosages. In the initial phase of protocol implementation presented here, we matched the current formulary of chemotherapeutics with the most common diagnosis encountered at the hospital. We then built chemotherapy order sets based on this information.
A team was set up which included the Chief Medical Information Officer, an Oncologist and an Oncology Pharmacist. A review of the most common diagnosis encountered at Binaytara Foundation Cancer Center was conducted. A complete list of chemotherapeutic agents available for prescribing was obtained at the hospital. We then reviewed current standard-of-practice treatment protocols, recent clinical data as well as national guidelines. After compiling our data, we met as a team to rank the order of specific chemotherapy protocol build, prioritizing the most frequently used regimens first to finalize the chemotherapy protocol. Given the scale of the endeavor and complexity of the chemotherapy order sets, the team decided to roll out a limited number of chemotherapy order sets in the initial phase of protocol design. The first chemotherapy protocol designed was the most intricate as it served as a template to set up work flow, establish institutional treatment guidelines including antiemetic groups, hypersensitivity protocols, and treatment parameters, as well as maintain clinical consistency and uniformity across all future protocols. Once all of these items were in place and the order set was finalized, it was then given to the Karexpert IT to team to be incorporated into the EMR.
This is an ongoing process wherein only the initial phase has been implemented. We hope to present our full data in the future.
Implementation of chemotherapy order sets in Karexpert EMR has been an important milestone at Binaytara Foundation Cancer Center. Chemotherapy order sets help improve efficiency and safety of the care provided. This is especially impactful in under resourced settings.
Our experience of implementing chemotherapy order sets in Karexpert EMR is a proof of concept that such customization of EMR can be achieved outside of the major EMR providers widely available in North America. We hope to build upon our initial success and develop a robust chemotherapy ordering menu in the near future.