Table 1.
Incorporation of IOM Elements Into Care Plan Prepared Within EHR
| Element Needed for Breast Cancer Treatment Summary and Care Plan4,9,12 | Method One: Automatic Import | Method Two: One-Time Manual Entry | Method Three: Repeated Manual Entry |
|---|---|---|---|
| Summary | |||
| Tests performed | |||
| Diagnostic or screening mammogram | — | — | X |
| Ultrasound, MRI | — | — | X |
| Tumor | |||
| Biopsy, receptors, histology, lymphovascular invasion, margins, grade | — | — | X |
| Cancer type | X* | — | — |
| TNM stage | — | X† | — |
| Surgery | |||
| Types of/dates of complications | — | — | X |
| Chemotherapy | |||
| Regimen name, drugs, dates of first and last treatments | — | X† | — |
| Total lifetime dosage | X‡ | — | — |
| Complications/toxicities experienced | — | — | X |
| Radiation therapy | |||
| Total dose and type, dates of first and last treatments | — | — | X |
| Endocrine therapy | |||
| Drugs used, dates of first and last treatments | — | — | X |
| Reconstruction | |||
| Type if applicable and date | — | — | X |
| Trials | |||
| Clinical trial participation and trial name | — | — | X |
| Imaging | |||
| Staging studies (CT, PET, bone scan) | — | — | X |
| Left ventricular ejection fraction | X§ | — | — |
| General information | |||
| Menstrual status, genetic testing | — | — | X |
| Follow-Up | |||
| Contact information | |||
| Treating institutions and providers | X‖ | — | — |
| Referrals | |||
| Supportive services | — | X | — |
| Health maintenance | |||
| Recovery from toxicities | — | X | — |
| Healthy behavior recommendations | — | X¶ | — |
| Last mammogram | X | — | — |
| Laboratory orders, colonoscopies, Pap, bone densitometry | X | — | — |
| Screening | |||
| Recommended screening and schedule | — | X¶ | — |
| Late/long-term effects, screening, and symptoms of such | — | X¶ | — |
| Signs of recurrence and second tumors | — | X | — |
| Resources | |||
| Effects of cancer on marital/partner relationship, sexual functioning, work, and parenting; potential future need for psychosocial support | — | X | — |
| Insurance, employment, financial concerns | — | X | — |
| Genetic counseling and testing, chemoprevention | — | X | — |
| Referrals to specific follow-up care providers, support groups, and PCPs | — | X | — |
| Cancer-related resources and information | — | X | — |
| Participant seen entirely within UW system | 6 | 14 | 15 |
| Participant seen entirely outside UW system for surgery, chemotherapy, and/or radiation therapy | 2 | 14 | 19 |
Abbreviations: CT, computed tomography; EHR, electronic health record; IOM, Institute of Medicine; MRI, magnetic resonance imaging; PCP, primary care provider; PET, positron emission tomography; UW, University of Wisconsin.
Available from International Classification of Diseases (ninth revision) code but did not usually specify side and thus not used.
Although an option, the information had generally not been entered and thus was not available for automatic import, or providers were not satisfied by formatting, clarity, and so on.
Patients seen after 2011 had adequate information to accurately calculate lifetime doses for anthracyclines.
Could be automatically imported if echocardiogram.
Only for PCP.
Required editing in order to individualize.