Integrating EMR Into the Clinical Management of CAR T-Cell Therapy Improves Patient Care

Because chimeric antigen receptor (CAR) T-cell therapy is still relatively new to the cancer treatment landscape, it is not fully developed in the electronic medical record (EMR). However, utilizing EMR for patients receiving CAR T cells may provide better care for patients.

Adding CAR T-cell therapy to EMRs requires collaboration among both the EMR and clinical teams, such as the providers and nurses. CAR T cells are not integrated yet into the EMR system, so the tools need to be designed from scratch. The EMR team can get a better understanding of the workflow and the needs of this specific patient population.

The priority in this space is creating nursing documentation for specialized orders for patients. Further implementation will require best practice advisories. Overall, EMR has triggers that recognize patient traits that can help drive decision making for providers.

In an interview with Targeted Oncology, Andrea Price, APN, associate director for Clinical Research at Washington University School of Medicine, discussed the importance of integrating the EMR team into the clinical care team for the treatment of patients with cancer receiving CAR T-cell therapy. She also shared advice for the community oncologist regarding patients with cancer who have received CAR T cells as treatment and her experience on the EMR team.

TARGETED ONCOLOGY: What is the value of EMR when using CAR T-cell therapies?

Price: EMR is what we use to drive our ordering process for CAR T cells, but more importantly, it has allowed us to dive into what the nursing considerations are for how you can document how patients are receiving CAR T-cell therapy and how we can capture useful assessments to help drive their care for side effects and toxicities, especially when the patient starts to decline. We are trying to capture that in a meaningful way to help nurses and physicians make the right decision every step along the way.

TARGETED ONCOLOGY: What are the considerations you discussed at the 2020 TCT Meetings?

Price: We are discussing ordering tools and documentation both from the nurse and provider to give them a space to document CAR T-specific assessments. We also discussed how we can leverage reporting that nurses and physicians both may need after the therapy is given. Now that we have these building blocks, we highlighted how we can give more robust tools for more clinical decision making, so things that EPIC can automatically do, warn you, different algorithms you can build in the system to help nurses and providers care for these patients.

TARGETED ONCOLOGY: What are the challenges in this space?

Price: The challenge is that CAR T-cell therapy doesn’t seem new to providers, but CAR T to the EMR seems new. It wasn’t necessarily built for this type of therapy, which requires a lot of collaboration with your EMR team to make it fit the workflows and to fit this specific patient population. The challenge is that it does not come out of the box with the tools you need. You have to design them from the group up.

TARGETED ONCOLOGY: What are the next steps for implementing this?

Price: We have implemented our top priorities, which we felt we needed right away, which was nursing documentation, which was specialized orders for these patients. Further implementation is where we will get into the more exciting best practice advisories, but there are these triggers in EPIC that recognize special traits of a patient that is documented on to help providers drive decision making. That is what we will be doing next, but the challenge is we don’t want to over notify providers or nurses, so drilling down the specific patients within the EMR that we want to do this work on.

TARGETED ONCOLOGY: What does the community oncologist need to know about this right now?

Price: In terms of the community, it is important to know that when a patient is seen at a specialized center, the team caring for this patient not only involves the physician and the nurse but also the EMR team and the informatics team to give this patient very specialized care when they are getting these more advanced therapies. We consider ourselves a part of this team, which is the fun piece to this. We are very integrated into the clinical team to give them the tools they need.

TARGETED ONCOLOGY: What is the takeaway message from this?

Price: Our message is to fold in your EMR team into your clinical team and make them a part of the team that is helping care for this patient. The more time you give them to understand these workflows by folding them into your processes, the better they are going to be able to build this system around what your needs are, which is what I think we have accomplished here. We need to build this relationship and give a structure so when new therapies come out and new challenges are presented both in research and standard care therapies, everybody is at the table to make the modifications and throw out ideas, so everyone has what they need.