Chapter 15: Electronic Medical Records at MD Anderson, Yesterday and Today
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Description
Dr. Buzdar begins this chapter by noting that, though MD Anderson was slow to update its electronic medical records system, it was an early adopter of the technology, developing a home-grown system, ClinicStation. He sketches come of the issues involved with the new system, Epic, that was adopted to integrate all patient records and provide some additional features. Dr. Buzdar gives the example of patient consent forms to participate in clinical trials: this is now fully electronic and to date fifty thousand patient consents for trials have been processed electronically. He also explains that key elements of all the protocols in which a patient is involved is accessible through Epic. Dr. Buzdar also explains that, at MD Anderson, each patient has always only had one medical record, not a separate set of records for ambulatory and inpatient care, as is the norm elsewhere.
Identifier
BuzdarA_02_20170216_C15
Publication Date
2-16-2017
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Building the Institution; MD Anderson History; Research; Devices, Drugs, Procedures; Multi-disciplinary Approaches; Patients; Patients, Treatment, Survivors; Technology and R&D
Transcript
Tacey A. Rosolowski, PhD:
+ Can you tell me, what are sort of the, in your mind as you're looking at your committee work, your administrative work, you know what are some of the areas you've worked on that you feel have had the most impact on the institution, something that really changed care, changed perspective.
Aman Buzdar, MD:
I don't think I can say that I did anything which had major impact, because the institution is huge, and most of the things require a huge team effort to make things.
Tacey A. Rosolowski, PhD:
Sure. Well then, you know, what are the things that you participated in. I mean obviously, the research nurse initiative is huge. What are some other things that you've participated in, that you felt made an impact? We talked about the algorithms, the Clinical Effectiveness Committee last time.
Aman Buzdar, MD:
I don't know. I think the thing which we're trying to do is now, we have electronic medical record system, which I was involved from day one in that.
Tacey A. Rosolowski, PhD:
When did you start getting involved with that? What is day one, what year was day one?
Aman Buzdar, MD:
Day one, it was almost like close to now, four years ago, when it started, because we had homegrown electronic health record system which was called ClinicStation, and we went into this, what we call now Epic. So we used to have these meetings every two weeks or every week, until the program went live, and even after that, and I am still leading some of the subcommittees. We made sure now, all the previous electronic records which were on a homegrown platform which was started in the '90s, have been moved into this new Epic. And, on day one, we also made sure that we have over a thousand plus research clinical trials that on day one, when the switch was flipped, it identified who are those thousands of patients on research studies, and which research study they are on. Also, we made sure that their consents are electronic, means that you don't throw a piece of paper in front of the patient, that we implemented it about more than four years before the current electronic system. It was even the previous old system, it was working very well. We made it totally electronic, that patient will -- you could print it out, a blank consent, which was protocol specific, that this is your cancer, this is what the standard treatment is, this is the research, these are the potential harms which can happen and these are maybe potential benefits. I played a very pivotal role. So the thing is, we have now, close to over 50,000 women, and not women, but I mean patients, have been consented totally electronically. We have gotten rid of all the paper. That has been a combined effort with our information technology and my office, and we made sure that all the protocols, key elements, when you are sitting on a computer terminal, you want to see that this patient, first it automatically shows that here, the patient is on a research study, it will show. If a patient is participating in four, five, six different studies, it will show five, six different icons, and you can click on that, it will take you to what study the patient is on, and you can open that study information.
Tacey A. Rosolowski, PhD:
Now, tell me why. What are the various ways in which that information is important?
Aman Buzdar, MD:
Important is you need to know exactly when, let's say that I am the doctor, you are the patient, that the patient sitting in front of you, what study, because this is a team approach. If I treated that patient on a research study, I am out of town and you are seeing that patient on my behalf, you should be able to, as you open the patient screen, it should tell, this patient is on this. And if you are not familiar with that, you click on another icon, it will take you to the protocol, it shows what is the detail of the protocol. You want to see whether the patient has agreed to consent. You click on a little, it's called iConsent, it shows, here is the whole consent and here in the patient's signature.
Tacey A. Rosolowski, PhD:
Now, when a patient is on multiple studies of this kind, do all of the PIs, or representatives from these different studies, they're all part of the individual's care team, is that the case?
Aman Buzdar, MD:
Yes. Each aspect of it. Let's say that a patient is getting chemotherapy for prevention of cancer recurrence, but the patient may be having, say some side effects like tingling or numbness and things like that. The patient may be on a study, to see whether we could modify that, so that is another group where our symptom management may be having that patient on that study. Or a patient might have had significant nausea, vomiting, and patient may be in another study where we're evaluating different nausea medication which will help the patient better than that. So that's why the patients could be on multiple studies.
Tacey A. Rosolowski, PhD:
But everybody needs to know what everybody else is doing.
Aman Buzdar, MD:
And you could see it exactly as you open the screen, it tells.
Tacey A. Rosolowski, PhD:
Yeah, interesting, wow. Now, when you said you were involved in the electronic medical records, was it from this perspective, of your role as VP of clinical research, or was it more in general?
Aman Buzdar, MD:
I played both roles, because I was asked to be on the executive committee oversight. So, not only just from being a physician who treats the patient in and outside the clinical trials. Also, the most important thing from my point of view was that I wanted these things integrated into the system.
Tacey A. Rosolowski, PhD:
Absolutely.
Aman Buzdar, MD:
And we are still working on trying to refine it even better.
Tacey A. Rosolowski, PhD:
So, I mean obviously, the electronic medical records has been a huge subject of conversation for a while. I had a one basic question, is a number of people who have come here from other institutions have said that MD Anderson was kind of slow in adopting something that was more comprehensive. You know, and I'm wondering if you agree with that or if you do, what you think the hesitation was about going to a more comprehensive system. It's funny, the siloing in this institution, you know there's a lot of smaller people doing their -- you know, they're doing their own thing, like with the tissue banks. So I'm curious what your perspective was on that vis-Ã -vis the electronic medical records.
Aman Buzdar, MD:
Because the thing is, our homegrown electronic system started here. At that point, there was no national standard, electronic health record. When we started our own electronic records, we were at the forefront of it, but once IT from outside got involved, they were outpacing our capabilities and it became fairly clear to us, even though we were spending sizeable resources, but we were not Microsoft, Google company, that we are going to be able to catch. This is a cancer center. So it became very clear that we need to get an out-of-the-box solution, so that decision was made about four years ago, and we sunset our own system and everything which was previously from patient one, has been transferred into the new system. It was a huge thing, but we were somewhat, I would say, as you pointed out, late getting into this, but we actually now, our system is fully integrated. Even though there are a number of other cancer centers which are using the electronic medical record, Epic, which we are using. But we have almost all of their capabilities fully integrated in ours, whereas in a number of other places, they may have parts of it integrated.
Tacey A. Rosolowski, PhD:
Now, what are these elements of integration that you're referring to, that are so powerful?
Aman Buzdar, MD:
Powerful is to be able to see orders written. Having a single source of the document, patient financial information, consenting. Even the consent tool which I described to you --each protocol has to have a specific consent-- the current electronic medical record which we have, Epic, it doesn't have that. We developed this, so if a patient has ten pages consent, it is electronically downloaded into the system with the interface with Epic. If the patient says yes, you click there, that consent shows up on the screen, the patient signs it, it goes into Epic. That is integration of a separate system. Now, Epic is thinking of -- a few days ago, me and Dr. Wilding and eight, nine of our senior other leadership people, that they are thinking of it maybe in 2018, they may come out with an electronic research consent document. So a lot of these things, even though we had it over here and we have a lot of things which are interfacing with our Epic, which is very unique, it is maximum so that we have one source of truth.
Tacey A. Rosolowski, PhD:
One source of truth you said?
Aman Buzdar, MD:
Mm-hmm. Because that's the source document.
Tacey A. Rosolowski, PhD:
Yeah, absolutely, absolutely, and you know, very complex too. I've seen, in the archives, some of the early patient records, and they're pretty amazing to read, not only from the limitations of what could be done, but just the way in which they're kind of a baggy mess.
Aman Buzdar, MD:
A patient chart could be all those things sitting, and some of the patients who were [gestures]--
Tacey A. Rosolowski, PhD:
Yeah, ten notebooks.
Aman Buzdar, MD:
It will be this thick. The patient will be carrying those things in a little go-cart in front of them.
Tacey A. Rosolowski, PhD:
Yeah, exactly. Well, and that was radical too, when a patient could actually carry their chart from one part of the institution to another, to make things go faster.
Aman Buzdar, MD:
That is one thing which has been very unique. In a lot of places, outpatient and inpatient information is separate, whereas from over here, from day one, our medical record has been only one medical record, even during the time when it was a paper medical record. Inpatient, outpatient, it was the same record.
Tacey A. Rosolowski, PhD:
Why is that significant?
Aman Buzdar, MD:
Because they don't have to look for another piece somewhere else, hidden, because usually, --
Tacey A. Rosolowski, PhD:
Because an inpatient can also move back and forth between inpatient and outpatient.
Aman Buzdar, MD:
All the information is in one chart.
Tacey A. Rosolowski, PhD:
So it's just a patient, not an inpatient, not an outpatient.
Aman Buzdar, MD:
It's not an inpatient, outpatient.
Tacey A. Rosolowski, PhD:
Yeah, okay. Yeah, I hadn't really thought about that but that's…
Aman Buzdar, MD:
That means there is everything which is being done to the patient, the disease is causing that, it's in one source document.  
Recommended Citation
Buzdar, Aman U. MD and Rosolowski, Tacey A. PhD, "Chapter 15: Electronic Medical Records at MD Anderson, Yesterday and Today" (2017). Interview Chapters. 576.
https://openworks.mdanderson.org/mchv_interviewchapters/576
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