Integration of a clinical pathways software into an EHR in a large, multisite, hospital-affiliated community oncology setting.

129 Background: Via Oncology (Via) is a decision support tool that integrates patient information, their disease, and goals of care to develop a treatment algorithm. Via prioritizes treatments by efficacy first, toxicity second, and cost third. The recommended regimen is offered to the doctor and patient who may accept it or choose an off pathway treatment. The pathways are updated quarterly and are expected to speed the integration of new treatments into practice, standardize therapy, improve quality, and decrease cost. Physicians are often unaware that a trial is available for a patient and EHR's are not commonly used to facilitate accrual to clinical trials. A pathway system could also alert doctors to the availability of a clinical trial and is designed to increase accrual to clinical trials.

METHODS: The integration of Via into the Epic EHR was facilitated by 3 major interfaces: patient information sent from the EHR to Via, the providers' schedules sent from the EHR to Via, and the protocol selected in Via sent back to the EHR. Within the decision algorithm, clinical trials were recommended as the first option in all lines of therapy when available.

RESULTS: After 11 months and 103,515 visits, the visit capture rate was 82.7%%. With 3,844 decisions made, 83.9% of all treatment decisions were on pathway. Clinical trial enrollment was 122 patients in the 459 days prior to Via implementation, and 102 patients in the 271 days afterwards. This increase in accrual rate was significant (p = 0.00174.) Conclusions: The pathway program was rapidly accepted by physicians and the recommendations were commonly accepted. The subsequent increase in clinical accrual, while not definitive of causation, is promising. An upgrade of the Epic EHR is planned in the near future. A single log in to open Via and the EHR concomitantly is planned. An additional interface to bring staging information from the EHR to Via is being planned.