The radiation oncology department at Loyola University Medical Center has taken advantage of ARIA® Connect, a set of standardized interfaces that bridge the gap between the ARIA oncology information system and the Epic® electronic health record (EHR) used by the larger medical center, resulting in improved communication between the RT department and the wider multidisciplinary team. This article highlights how Loyola approached the integration of the two systems.
Like most radiation oncology departments, Loyola University Medical Center, in the suburbs of Chicago, manages its clinical workflow with a radiation-oncology-specific electronic health record (rEHR) that is separate from the hospital EHR (hEHR). Since 2015, that rEHR has been the ARIA system. In that time, the department has leveraged every capability of its rEHR to improve efficiency and care. While the rEHR is essential to a well-run radiation oncology practice, the department recognized the value of improving communications with the broader multidisciplinary team within the hospital who are charged with the care of patients.
“The separation of the EHRs can potentially lead to failures in coordination of care or delays in diagnosis and management of medical issues and, ultimately to provider and patient confusion and frustration,” noted the authors of a 2017 Loyola report on “Improving the Accessibility of Patient Care Through Integration of the Hospital and Radiation Oncology Electronic Health Records.”1
Before undertaking integration of the two EHRs, the Loyola project team surveyed providers outside the radiation oncology department, including physicians, nurses, dieticians, and psychologists, asking them to rate the importance and the accessibility of the encounters and documents most important to them. “We surveyed the multidisciplinary care team before implementing connectivity between ARIA and Epic,” explained Abhishek Solanki, MD, assistant professor and departmental quality director, and the report’s lead author. “We asked if they can coordinate care using information currently available in Epic. For example, do they know when the patient starts radiation treatment? Or do they know when the patient finishes so that they can coordinate follow-up care? We asked, do you need this information, how important is it to your practice, and is it accessible to you?”
Rakesh Patel, PhD, assistant professor of Radiation Oncology
Many options exist for the bidirectional exchange of data between ARIA and hospital informational systems. Using this feedback, the project team implemented interfaces between the EHRs, making the highest priority information from ARIA available in Epic. The pre-integration survey not only guided integration decisions but also provided a baseline for assessing project results.
So what RT information did Loyola providers most want to access easily? Fifty percent or more wanted to see consultation notes, completion summaries, physician planning directives, CT simulation dates, first and last dates of treatment, procedure notes, and follow up notes.
Based on the pre-integration survey feedback, Loyola established several interfaces between the hEHR and rEHR. In addition to exporting charges to the hospital billing system, interfaces now in place include the following:
- Admission, discharge, transfer (ADT) information and patient demographics come from Epic into ARIA.
- A document interface goes from ARIA to Epic to make Epic as complete a medical record as possible.
- Scheduling interfaces mirror appointments in both ARIA and Epic. Some appointments, such as consults, on treatment visits and post-treatment follow ups are scheduled in Epic and mirrored in ARIA. Others, such as simulation and treatment appointments are scheduled in ARIA and flow back to Epic.
Murat Surucu, PhD, associate professor and chief of clinical physics pointed out that the implementation of interfaces to bridge separate EHRs is not a trivial effort because two systems may do some of the same things differently. For example: to transfer electronic documents successfully from ARIA to Epic, each document must contain the hospital account record number. “Training the staff about the workflow changes that occur after integration is essential,” said Surucu. “Once you understand the workflow and set up the system, it works from that time on.” To help bridge the gap between ARIA and Epic or other hEHRs, Varian offers ARIA Connect. ARIA Connect includes interface engines and basic implementations for information exchange. Services for customized interfaces are also available.
So what were the results after the integration of the Loyola’s rEHR and the hEHR? Do Epic users report better access to information they value? “When we surveyed the providers again, we found a significant improvement in most of the items made visible in the Epic system through the interface,” reported Surucu. More details about the process and the results can be found in this report published by the American Society of Clinical Oncology.
“By integrating our hEHR and rEHR, we improved the communication of patient care between the RT department and the multidisciplinary team,” concluded Solanki. “We recommend that institutions pursue and support integration of the EHRs to improve the quality of care provided to patients with cancer.”
1Solanki AA, Surucu M, Bajaj A et al. Improving the Accessibility of Patient Care Through Integration of the Hospital and Radiation Oncology Electronic Health Records. JCO Clinical Cancer Informatics 2017 :1, 1-8 DOI: 10.1200/CCI.17.00063
Epic® is a registered trademark of Epic Systems, Inc. Varian Medical Systems is not affiliated with Epic Systems, Inc.
The information captured herein represents the genuine experience of the attributed individuals and may not necessarily represent the views of Varian or the above referenced institution. Individuals were not compensated for their participation.
The ARIA® oncology information system is a comprehensive information and image management solution for overseeing all aspects of oncology care. It combines radiation, medical and surgical oncology information into a complete, oncology-specific EMR to enabling the management of the patient's entire journey—from initial diagnosis through post-treatment follow-up. ARIA also provides standardized and customizable interfaces for the bidirectional exchange of data between ARIA and the electronic record systems used by hospitals (hEHR). Standardized interfaces give both ARIA and hEHR users a more complete patient picture which enhances the efficiency, quality and safety of care. For example, in addition to the data types Loyola is transferring between systems, ARIA and Epic can be configured to also exchange radiation treatment summaries, lab results, charges, and other important data. Benefits of ARIA data exchange solutions include:
- Less variability through standardization
- Greater efficiency through simple integrated workflows
- Time saved by eliminating duplicate data entry