Purpose: Prostate cancer and lung cancer are the most commonly diagnosed malignancies in the VHA. Recent approval of several new treatment options has increased the complexity of cancer care. A more efficient mechanism for capturing data to monitor cancer care quality in the VHA is essential. Currently, the large amount of free text information in the medical record makes it difficult to retrieve necessary data to assess the quality of cancer care in a prospective and continuous manner. Reminder dialogs allow data to be entered and extracted in a standardized manner that will enable us to more efficiently monitor quality of cancer care.
Methods: Three clinical reminder dialog templates have been developed: lung cancer, prostate cancer, and a cancer-symptom assessment scale. The content of the lung and prostate cancer templates were initially determined by evidence and/or consensus-based quality measures. The cancer-symptom assessment scale was adapted from the Edmonton Symptom Assessment System tool. All of the templates have undergone formal usability testing, and modifications were made to each template based on this feedback.
Results: The prostate template underwent 2 types of formal end-user testing, a pluralistic walk through and a traditional usability test. The System Usability Score was 57.5 (national average = 68). Substantial improvements and revisions were made to the template based on the findings of the pluralistic walkthrough. A key finding from the traditional usability study was the desire for a mechanism to “pull-in” the diagnosis and treatment histories into the progress note. The final version of this template now contains a heading that displays previously entered information in the form of health factors. The new version of the lung template also contains a header. The symptom assessment scale underwent a traditional usability study. Morae software was used to capture end-user real-time data entries. The System Usability Score was 92.1. Twenty-one areas were identified as problematic. Most were minor issues, but 4 areas were considered critical. Six significant changes were made to the template based on this information. The prostate template and cancer symptom assessment scale are planned for national release by December 2014.
Conclusions: Using reminder dialogs for documentation allows for the embedding of health factors in the CPRS. Health factors provide a mechanism to extract data from the CPRS in a useful manner. These templates enable facilities to monitor cancer care quality and best practices.