Online opportunity for quality, efficiency With the July acquisition of iKnowMed, an oncology specific electronic medical records (EMR) system, US Oncology found a perfect match. The product has deep and broad oncology content, focuses on the infusion suite that is unique to oncology care, and has the ability to enhance the safety and efficiency of clinical processes. As a web-based product, iKnowMed has the added benefit of being available 24/7 from any location with high-speed Internet connection. iKnowMed is also a proven product that has been actively used by over 130 physicians over the past seven years. The feedback and experience obtained during US Oncology's evaluation of the product were overwhelmingly positive. "Representative comments from physicians and practice staff were that iKnowMed has enabled them to access more and more complete patient data without the need to search and retrieve paper charts, thereby improving efficiency and effectiveness," said Kathy Lokay, vice president of Medical Oncology Decision Support and general manager of iKnowMed. "We also heard that iKnowMed gives practices a greater degree of precision with charge capture and E&M coding documentation. "One practice administrator told us that five months after 'going live,' the system is showing real promise with patient-care management, decision making and safety, which were the main reasons his practice chose the product in the first place." In addition to the software, US Oncology acquired the iKnowMed workforce of 40 highly experienced employees and is now offering iKnowMed exclusively to network members at attractive rates. "We believe from discussions to date that network members will take advantage of this tremendous opportunity to have a consistent clinical information platform that can adapt to changing needs," said Lokay. Reasons iKnowMed is an attractive option include: Chart happy. According to a study commissioned by one of the largest US Oncology-affiliated practices, an average of 2,000 chart-pulls per physician per month cost an estimated $4 each, or $96,000 per physician per year. Also, over 80 percent of these chart-pulls are not related to patient visits. When charts are available online to all clinicians interacting with the patient at all times, those costs are greatly reduced, and patients benefit from decreased wait times and better coordination of care. Charge capture. Simple human error can eventually add up to a significant loss in top-line revenue even before reduced Medicare reimbursement enters the picture. "But when charge capture automatically occurs as a by-product of clinical EMR charting, the possibility of error or missed charges is greatly reduced," said Lokay. "For one existing iKnowMed user, losses of about 6 percent were down to less than one percent after implementing the system." iKnowMed also provides a significant improvement to the charge entry/billing process. Billing staff has immediate access to the chart, which is especially useful where there are satellite offices. Practices can save the courier and administrative costs of shuttling charts from one location to the next. One billing manager reported that with iKnowMed, a claim can be appealed in five minutes versus five days. Robust reporting. All iKnowMed implementations include access to a reporting center that provides decision-making support tools, such as Treatment Patterns by Diagnosis/Stage, Supportive Care Agents by Regimen and many other key reports. And ad-hoc reports can be run locally as needed by the practice. "The integration of paper information into iKnowMed will provide an unprecedented ability to analyze information, both for a practice's internal use as a network tool, as well as for external third parties such as pharmaceutical manufacturers and managed-care payors," said Todd Schonherz, vice president of Information Technology. Lighter workload. Nurses' charting time is greatly reduced when the entire documentation process is completed through iKnowMed - from chemo administration time to patient assessment. "One nurse manager reported that her nurses can chart a five-drug regimen in less than four minutes, and the documentation is better than when they charted manually," said Lokay. "In addition, the billing staff has an easier time appealing claims." Real-time. iKnowMed works seamlessly in the background during a patient encounter, providing real-time error checking, safety alerts and automatic dose calculations. The system also has the ability to do high-level research screening for potential study eligibility. That means quicker identification of study candidates and streamlining of practices' clinical trial processes by having research protocols set up in iKnowMed for online treatment ordering. Implementation and rollout To ease the transition from paper to electronic charts, affiliated practices can choose from two levels of implementation. "Level 1" requires inputting only a limited number of data elements, as well as ordering all chemotherapy, in-house medications and external prescriptions through iKnowMed. Once in the system, nurses can clearly read orders from that day forward and manage the patient's treatment online. In addition, an imbedded dictation and transcription module allows for seamless dictation of encounter notes directly into the patient's electronic chart. "Also standard are interfaces with the Practice Management System for demographic and scheduling information," said Schonherz, "and with the practice's lab information system for real-time viewing and approval of all relevant lab values in the patient's chart." In its fullest capacity, "Level 2" iKnowMed allows physicians to use a combination of "point-and-click" (structured text) and dictation to document the patient encounter. With the structured text method, the note becomes even more thorough as the software guides the user to answer in more detail when possible. This enhanced level of detail enables in-depth reporting and analysis on the practice's clinical information, as well as potential improvements in documentation. Transition to iKnowMed will also be facilitated by a roll-out approach, implementing only a limited number of sites over the next few months. "This will help ensure the product's functionality and speed before a broader roll out," said Lokay. Plans are already under way for iKnowMed to be launched at Rocky Mountain Cancer Centers' Boulder division in mid-November, and for an additional practice site to go online by the end of the year. Beginning in the first quarter of 2005, the pace of implementations will increase significantly. In addition, forums are being established for network-affiliated clinicians' guidance on product development and enhancements. Three user groups comprised of physicians, clinicians and administrators using iKnowMed will meet via conference call on a monthly basis. An Executive Advisory Board will provide financial oversight and prioritize the strategic development of the product.