Discussion Question 5.1 -LP4-15

The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama.After reviewing the article, give a brief summary of how electronic records can be used in non-acute care settings and settings other than hospitals.

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The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama
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US National Library of Medicine
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Perspect Health Inf Manag
v.9(Spring); Spring 2012
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Article | PubReader | ePub (beta) | PDF
(142K) | Citation
Perspect Health Inf Manag. 2012 Spring; 9(Spring): 1f.
Published online 2012 Apr 1.
PMCID: PMC3329210
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Shannon H Houser, PhD, MPH, RHIA, an associate professor of health services
administration, Shannon Colquitt, RHIA, an MPI project supervisor, Kay Clements, MA,
RHIA, CCS, CPC, a health information management program director, and
Susan Hart-Hester, PhD, a professor of family medicine and director of the Health
Professional Shortage Core in the Delta Regional Institute
Perceptions regarding electronic health record
among health
Inf Manag. 2008]
Electronic health records and support for primary
care teamwork. [J Am Med Inform Assoc. 2015]
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Electronic Health Record Challenges,
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As the use of information technology within the healthcare setting increases,
the impact of bridging registry data with electronic health records (EHRs)
must be addressed. Current EHR implementation may create benefits as well
as challenges to cancer registries in areas such as policies and regulations,
data quality, reporting, management, staffing, and training. The purpose of
this study was to assess 1) the status of EHR usage in cancer registries, 2) the
impact of EHR usage on cancer registries, and 3) the benefits and challenges
of EHR usage for cancer registries in Alabama. The study method consisted
of a voluntary survey provided to participants at the Alabama Cancer
Registry Association 2009 annual conference. Forty-three respondents
completed the survey. Data indicated that the major benefits of EHR use for
the cancer registry included more complete treatment information available to
clinicians and researchers, more time for retrieving and analyzing data for
clinicians and researchers, and better tracking of patient follow-up. The major
challenges included lack of adequate resources, lack of medical staff support,
and changing data standards. The conclusion of the study indicates that
understanding the impacts and challenges of EHR usage within cancer
registries has implications for public health data management, data reporting,
and policy issues.
Key words: electronic health records, cancer registry, information
Electronic health records implementation: an
evaluation of information system
[Int J Med
IT Is From Mars and Physicians From Venus:
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Established in 1992 through the Cancer Registries Amendment Act, the
National Program of Cancer Registries (NPCR) administered by the Centers
for Disease Control and Prevention (CDC) collects data on a number of
variables associated with cancer, such as occurrence, type, extent, location,
and initial treatment,1 from state cancer registries. Summary state- and
federal-level statistics provided through the NPCR facilitate informed
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The Impact of Electronic Health Record Usage on
Cancer Registry Systems in Alabama
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The Impact of Electronic Health Record
Usage on Cancer Registry Systems in
The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama
decision making that impacts healthcare policy and regulations as well as
education and training of healthcare professionals.2
State cancer registries provide a wide array of functions, including
monitoring cancer trends over time; determining cancer patterns in various
populations; guiding planning and evaluation of cancer control programs
(such as determining whether prevention, screening, and treatment efforts are
making a difference); helping set priorities for allocating health resources;
advancing clinical, epidemiologic, and health services research; and
providing information for a national database of cancer incidence.3 Two types
of national programs provide leadership for systematical collection,
dissemination, and interpretation of cancer data and serve as a resource for
research to address the cancer burden in the United States. The National
Hospital-based Cancer Program focuses on cancer data from hospital cancer
registries, while the National Population-based Cancer Program focuses on
geographically defined cancer registries such as those focusing on regional or
state populations.4
See more…
How common are electronic health records in the Uni
States? A summary of the evidence.[Health Aff (Millw
Use of electronic health records in U.S. hospitals.
[N Engl J
Historically, the process for data entry into cancer registries was completed
by a certified cancer registrar using a manual or electronic process for
documentation into paper or electronic forms. The path for data abstracting
within a cancer registry begins with the initial patient evaluation and
diagnosis followed by entry into a hospital registry database. A hospitalbased cancer registry collects information on all cancer patients who receive
services from a healthcare organization.5 Annual follow-up via phone or mail
is conducted to update the patient’s status. The case is reported to the state
cancer registry for research and incidence reporting.6
However, as the use of information technology within the healthcare setting
increases,7, 8 the impact of bridging registry data with electronic health
records (EHRs) must be addressed. Traditionally, the cancer registry has
maintained cancer case records in paper format. Current EHR implementation
may create benefits as well as challenges for cancer registries in areas such as
policies and regulations, data quality, reporting, management, staffing, and
training. The purpose of this study was to assess 1) the status of EHR usage
in cancer registries, 2) the impact of EHR usage on cancer registries, and 3)
the benefits and challenges of EHR usage for cancer registries in the state of
Go to:
Survey Sample and Procedure
A convenience sample was drawn from participants of the Alabama Cancer
Registry Association’s 2009 annual conference held in Birmingham,
Alabama. The annual conference is open to all cancer registrars and other
cancer-related and health information management professionals from the
state.9 A self-completed survey was distributed during the two-day
conference. Sixty cancer registrars attended this conference. All conference
attendees were eligible to participate in the survey. The survey was included
in each participant’s program package along with an informed-consent
document and written instructions regarding the study purpose and
procedures. In addition, a five-minute introduction and explanation of the
study and survey procedures was given by the study investigator each day
prior to the start of the conference sessions. Institutional review board
approval was obtained prior to conducting the survey. Study participants were
instructed to complete their surveys during the conference and return them to
The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama
a sealed drop box located at the conference registration desk. The survey was
anonymous, and no self-identifying information was collected or disclosed.
Survey Development and Measures
A survey was designed based upon a literature review pertaining to cancer
registries and the implementation of EHRs10 as well as interviews with local
cancer registrars. The survey questions focused on individual perceptions of
the impact of the EHR use in cancer registries. Using a five-point Likert scale
(1 = strongly disagree, 5 = strongly agree), participants were asked to rate
their perceptions of impacts (10 items), benefits (9 items), and challenges (9
items) of using EHRs in a cancer registry (see Table 1). Demographic
information such as job title, credentials, type of work setting, and healthcare
facility location were also collected. (See Table 2.)
Table 1
Mean and Standard Deviation of Impacts, Benefits, and Challenges to
Cancer Registry with Electronic Health Record (EHR) Usage (N = 43)
A. Impacts
On a scale of 1 to 5 (1= Strongly Disagree and 5 =
Strongly Agree), please rate how important the
following IMPACTS are in using the EHR in Cancer
Registry in healthcare facility.
1. Fulfill the Need to Share the Patient Record Information
4.33 (0.72)
among Healthcare Professionals
2. Reduce Healthcare Delivery Costs
3.89 (0.85)
3. Improve Quality in Data Documentation
4.24 (0.80)
4. Improve Clinical Process or Workflow Efficiency
4.28 (0.66)
5. Improve Monitoring Cancer Trends Over Time
4.19 (0.89)
6. Determine Cancer Patterns in Various Populations
4.14 (0.96)
7. Guide Planning and Evaluation of Cancer Control
3.73 (0.98)
8. Help Set Priorities for Allocating Health Resources
3.71 (0.97)
9. Advance Clinical, Epidemiologic, and Health Services
3.82 (0.94)
10. Provide Information for a National Database of Cancer
3.97 (1.00)
11. Other (please specify)
B. Benefits
On a scale of 1 to 5 (1= Strongly Disagree, and 5 =
Strongly Agree), please rate how important the
following BENEFITS are in using the EHR in Cancer
Registry in healthcare facility.
1. Improves Quality of Report Data to Internal and
4.11 (0.83)
External Users
2. Improve Workflow
4.11 (0.79)
The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama
A Impacts
Open in a separate window
Note: Response totals do not always equal 43 due to missing values.
Table 2
Characteristics of Survey Respondents (N = 43)
HIM director/administrator/manager
Cancer registrar/abstractor/analyst/coordinator 28 65
Work setting
Acute care hospital
27 63
Cancer center/clinic
State cancer registry
Educational institution
<300 beds 5 12 300–499 beds 14 33 =500 beds 9 Does not apply 15 35 Hospital bed size 21 Note: Percentage totals may not equal 100 due to rounding. The survey was designed to query the respondents’ implementation of EHRs within their healthcare facilities. We first asked: “Has your healthcare facility implemented electronic health record (EHR) in the Cancer Registry?” Five possible answers were listed: 1) “Yes, EHR has already been implemented, and is accessed in cancer registry”; 2) “Yes, EHR has already been implemented, but is not accessed by cancer registry”; 3) “No, EHR has not already been implemented, but it is in progress”; 4) “No, EHR has not already been implemented, but it is being considered”; 5) “No, EHR has not already been implemented, and there are no plans to implement EHR.” Respondents who marked “yes” for the first question were asked for additional details. For example, respondents were asked the length of time that EHRs had been implemented in their facility. In addition, these respondents were asked to describe the basic functions of EHR usage for cancer registries within their healthcare facilities. They were instructed to select all listed functions that applied to their usage of complete or partial EHRs within their cancer registry. Listed functions included review of patient clinical data and results, care plans, physician and other care provider's clinical documentation, care https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329210/ 4/11 4/6/2018 The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama coordination documentation, and regulatory reports. Table 3 provides the list of surveyed functions for EHR usage within a cancer registry. Table 3 Functions of Electronic Health Record Usage in Cancer Registry (N = 43) Function Percentage of Usage Physician and clinical documentation 56% Patient clinical data and results review 54% Care plans 28% Care coordination 28% Clinical and outcomes measurement 28% Quality reporting 23% Patient education 23% Clinical decision support 21% Medication reconciliation 18% Regulatory reporting 18% Analysis Excel and SPSS version 18 were used for data entry and data analyses. Descriptive analyses were applied for the demographic information and Likert-scale data summaries. By design, the unit analysis was based on individual respondents instead of on health facilities. Results Go to: Characteristics of Respondents We distributed 60 surveys, and 43 surveys were completed for a 71 percent response rate. The conference attendees represented 12 counties in Alabama and 25 health facilities (we obtained a count of health facilities from the registration list at the conference). Despite the fact that 55 of the 67 counties in Alabama are designated as “rural,”11 nearly all study participants (97 percent) were from urban facilities, compared to only 3 percent from rural areas. Almost two-thirds (65 percent) of the respondents held the position of cancer registrar, cancer abstractor, or cancer analyst. More than half were from acute care hospitals (63 percent); the remaining respondents were from the state cancer registry, a cancer center, or an educational institution (see Table 2). EHR Usage in Cancer Registries Figure 1 shows the status of EHR implementation in cancer registries within the state of Alabama. Thirty-four respondents were included in this item analysis. Respondents who did not answer or were not working in a cancer registry or other health facility were excluded from this analysis. A total of 20 respondents (59 percent), from seven different counties, reported using EHRs in the cancer registry at their facilities; 2 respondents (6 percent) had https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329210/ 5/11 4/6/2018 The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama implemented EHRs but were not using EHRs in the cancer registry; and the remaining 12 respondents (35 percent) had not completed implementation of EHRs or did not currently have EHRs in their facilities. It should be noted that these data reflect individual participant responses. Due to the lack of identifiers on the survey, data could not be sorted by facility; therefore, multiple respondents could be from the same facility. Figure 1 Status of EHR Usage with Cancer Registries Table 3 shows respondents’ data pertaining to the wide range of functions for usage of EHRs in cancer registries. More than half of the respondents who are currently using full or partial EHRs reported accessing the EHRs for physician and clinical documentation (56 percent) and patient clinical data and results review (54 percent). Some of the other functions included care plans (28 percent), care coordination (28 percent), clinical and outcomes measurement (28 percent), patient education (23 percent), quality reporting (23 percent), clinical decision support (21 percent), medication reconciliation (18 percent), and regulatory reporting (18 percent). Data indicate that more than 80 percent of these EHR functions are being used by acute care hospitals. Impact, Benefits, and Challenges of EHRs within Cancer Registries Table 1 illustrates the mean and standard deviation for each survey item related to impact, benefits, and challenges of EHR usage in cancer registries. On a scale of 1 to 5, the overall mean for each item ranged from 3.71 to 4.33 for impact, 3.86 to 4.28 for benefits, and 3.33 to 3.73 for challenges. Figure 2 shows respondent data regarding the impact of EHR usage in cancer registries. The highest-ranking responses regarding the impact of EHR usage in a cancer registry were 1) improved workflow efficiency, 2) shared patient record information, 3) improved data quality in data documentation, 4) determination of cancer patterns, and 5) improved monitoring for cancer trends. Figures 3 and 4 identify respondents’ feedback regarding the benefits and challenges of utilizing EHRs in their cancer registry. The top benefits of EHR use in a cancer registry included 1) more complete treatment information, 2) less time for case finding and data entry, 3) more available time for data retrieval and analysis, 4) improved completeness, accuracy, and timeliness, 5) better patient tracking for follow-up, and 6) improved workflow efficiency (see Figure 3). The top challenges to the utilization of EHRs within a cancer registry identified by respondents were 1) lack of adequate funding, 2) lack of medical staff support, 3) changing data https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329210/ 6/11 4/6/2018 The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama standards, 4) lack of full-time commitments, and 5) lack of a standardized data exchange (see Figure 4). Figure 2 Impact of EHR Use in Cancer Registry (N = 43) Perceptions regarding electronic health record implem [Perspect professionals Health Inf Ma among health information management An external file that holds a picture, illustration, etc. Object name is phim0009-0001f-f03.jpg Electronic health records in ambulatory care--a nation [N Engl J of physicians. Open in a separate window Figure 3 Benefits of EHR Use in Cancer Registry (N = 43) Figure 4 Challenges of EHR Use in Cancer Registry (N = 43) Respondents identified the following additional issues related to using EHRs within a cancer registry: 1) data accessibility issues, such as lacking access to a patient's complete health history in physician offices’ medical records and facility treatment records, or lacking access to other health facility records if the patient received care at multiple facilities; 2) documentation and data completeness issues, such as physicians’ documentation and difficulty using existing information with a complete cancer abstract; 3) support and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329210/ 7/11 4/6/2018 The Impact of Electronic Health Record Usage on Cancer Registry Systems in Alabama knowledge issues, such as a lack of support from administrators, and lack of clear understanding of the roles and functions of a cancer registry; and 4) the lack of resources, such as lack of funding, lack of sufficient staffing, and limited time to complete tasks. Discussion Go to: As information technology is increasingly utilized as a bridge between patient clinical records and registry data such as that contained in a cancer registry,12 it is important to understand the impact of this bridging process on the registry field. Survey responses from certified cancer registrars in Alabama address the impact of EHR usage on cancer registries ... Purchase answer to see full attachment

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