Within Research Information Technology at the Icahn School of Medicine, we use Epic to assist clinical and researchers with managing patient care and research studies.
We support accruement through two mechanisms in our electronic health records (EHR): Clinical Trial Recruitment Alerts (CTAs) and reports containing lists of eligible patients along with appointments.
We configure CTAs to enable researchers to search for patients who meet the screening criteria for a study and alert the research coordinator or investigator that the patient has expressed interest in the study. These alerts occur at the point of care and with a provider who knows the patient seeing the patient for routine care.
We capture study-specific data in a variety of ways:
- An intermediary system that transmits data between EPIC and other systems such as CTMS or Electronic Research Application Portal (ERAP)
- Enhanced documentation through Smart Data Elements, allowing for discrete data to be captured which can be bound to smart text, smart forms, and other smart tools
- Patient questionnaires via Personal Health Record (PHR), which gives patients direct online access to portions of the personal EMR where lab results, appointments, medications, immunizations, and more are stored for quick reference via the web. These questionnaires provide quick methods of communication as well between provider and patient, can be enabled for patients to answer questions based on specific study criteria, and can be completed online via PHR
- Patient questionnaires are also being developed to offer electronic consenting and, in the future, recruitment for clinical trials based on a patient’s medical conditions or interests
- Providing survey instruments related to patient care including Doc Flowsheets, an electronic flow sheet documentation tool that files values that are discrete and reportable and offers the flexibility to create cascading records depending on responses to specific questions. Based on Doc Flowsheet entries, providers may be notified of prospective candidates that match their criteria.
We offer questionnaire functionality allowing for collection of standard information on the questionnaire built into Epic. The clinician can select and document discretely and consistently, which allows for future reporting.
Study information can be pre-populated on sponsor electronic forms allowing research staff to complete and submit those forms without leaving the Hyperspace via the API link.
Interventions at the Point of Care
Our data management capabilities at the point of care include ancillary test ordering for labs, tests for study patients with a specific class of research, and study medication ordering.
Through Epic, we support study-specific order sets and can create Order Sets or SmartSets for each study that contain only "research" orders approved for that study.
Our clinical decision support includes in-basket messages that can be sent to research staff based on ADT events such as admissions to IP and ED, transfers, and discharges with dispositions of deceased. These messages can be synchronous, allowing the user to receive clinical results based upon pre-defined criteria and with the ability to send back situational responses, or asynchronous, triggering in-basket actions based on user responses.
We provide best practice advisories as reminders or warnings and pop-up notifications that may be employed and triggered under certain conditions and targeted for specific research scenarios. Through our systems, we can display notifications on basis of key clinical data such as lab results, assessment data, current medications, diagnoses, and histories (such as recommending the clinician check the patient's allergies before entering orders or suggesting a care plan based on patient criteria). Advisories may also subsequently trigger linked actions such as placing additional orders, initiating care plans, or sending in-basket messages.
Our health maintenance capabilities include the ability to define health maintenance topics into plans. Epic will generate automatic reminders when the plan is due or overdue. We also offer:
- Alternatives - Advisories that suggest alternative therapies are available as an alternative course of treatment when clinicians place orders
- Patient education/instructions as part of smartset or separately that can be tailored to a specific study
- Suggested smartsets – collections of orders can be suggested without creating an alert, tailored to the study
Other interventions at the point of care include reporting specific to EHR such as reporting to check for medications, diagnoses, and other patient safety concerns related to research studies; effectiveness of clinical decision support; and intervention specific data not in the data warehouse.