Purpose: The VHA has one of the largest and fastest growing cancer populations in the country. In 2009, there were 157,166 chemotherapy orders placed for 25,493 patients. Currently, the VHA clinical oncology environment uses a mixture of paper-based and computer-based practices with limited direct order entry of chemotherapy. The lack of order entry standardization often results in errors, adverse events, and inefficiencies. The purpose for creating the Chemotherapy Ordering Management System (COMS) is to provide an automated solution that will enhance capabilities, minimize errors, and meet the needs of VHA oncology services.
Methods: Oncology is a uniquely high-risk and high-complexity domain of health care that has not been effectively implemented in the existing electronic health record (EHR)—VistA. Unfortunately, oncology practices are hindered by the lack of specialized functionality within VA’s EHR. The CPRS lacks critical functions required for oncology. This creates a clinical environment that lacks standardization and limited direct order entry of chemotherapy. COMS is a web-based application that supports oncology health care teams in ordering, preparing, and documenting the administration of chemotherapy. COMS consists of a general application interface and several modules—Chemotherapy Template Order Source, Order Entry Management, Flow Sheet, Nursing Documentation, and End of Treatment Summary—that serve a specific purpose and provide functionality to support users in executing their roles and responsibilities in the treatment process. COMS interfaces and interacts with existing VHA clinical systems, modules and processes within CPRS and VistA. Specifically, COMS interacts with VA databases by retrieving patient information and writing pertinent information to provide 1 interface for entering information regarding the provision of oncology services to a patient. COMS will be deployed at 2 locations: the Durham VA Medical Center in Durham, North Carolina, and the VA Puget Sound Health Care System in Seattle and Tacoma, Washington. The cost of setting up and maintaining a chemotherapy commercial off-the-shelf (COTS) product within VHA is about $19,355,259 the first year and $1,429,638 every subsequent year. Field-testing will begin in the fall of 2014. COMS is currently being tested in the VHA test environment to make necessary changes to the application for enhanced clinical functionality and compliance with latest VA security guidelines and Office of Information & Technology (OI&T) site requirements. The use of COMS, as opposed to acquiring a COTS product, will create significant cost savings for VA.
Conclusions: The cost of setting up and maintaining a chemotherapy COTS product is estimated to be $19,355,259 in the first year and $1,429,638 in subsequent years. The already-developed COMS application only needs to be deployed to existing oncology sites and supported by existing staff. COMS is a government-furnished application that is the sole property of VA. It is a readily-deployable application that provides an enterprise tool for VHA Oncology Services nationwide. The Chemotherapy Ordering Management System is intended to be a safe and effective medication management system integrated into the VA EHR, allowing users to auto calculate treatment dosage, construct and share treatment plans, create standardized order sets for national use, document treatments given, respond to toxicities and follow-up recommendations at the conclusion of the course of therapy, reduce errors, and rework and improving efficiencies.
