Safe and reliable chemotherapy orders at the click of a mouse? Thanks to ChemoOrders.com, it's possible.
The Web site is the brainchild of Dr. Bruce Feinberg, president and CEO of Georgia Cancer Specialists, an Atlanta-based oncology and hematology practice. The site, which helps nurses, doctors and pharmacists create patient-specific chemotherapy orders quickly and accurately, grew out of a disease-management system developed by Feinberg's practice.
 Photos by BARRY WILLIAMS/Special |
| Dr. Bruce Feinberg and nurse Sandy English navigate ChemoOrders.com, a free online disease-management service that helps health care providers implement evidence-based chemotherapy protocols. |
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| Nurse Sandy English checks on Mildred Nobles' chemotherapy IV drip at Georgia Cancer Specialists. |
With new research, therapies and drugs, cancer treatment has become more complex in recent years.
"Cancer is actually 200 diseases that behave differently and require individualized protocols," Feinberg said.
Oncologists have always developed treatment regimens on a case-by-case basis, trusting their memories and their nurses' support to prescribe and manage protocols. Feinberg wanted to update the system and make it electronic.
Georgia Cancer Specialists began converting to electronic records in 1988. It was a rocky road — strewn with companies who went out of business and systems that didn't work — until Feinberg discovered NextGen Healthcare Information Systems about eight years ago.
NextGen agreed to work with Feinberg's practice to create a cancer-specific module that practitioners could use to write chemotherapy orders.
"The program did everything it was supposed to, but it was not user-friendly, so the staff didn't use it," Feinberg said. "It was like a lot of people's home-exercise equipment; it became a coat rack.
"I'm not a techie, but I had a vision of how it should work. It should go in logical sequences — from diagnosis to treatment to orders to patient education — the way clinicians' minds work. It should make their time on the computer less, not more."
With input from his staff, Feinberg told the software developers how to redesign the program so that it would meet the needs of his practice. It took 1,000 hours to develop, but the program proved to be a huge success for Georgia Cancer Specialists' 31 offices.
"I can order something now, on the computer, faster than I could say it to a nurse or pharmacist. It takes me about 90 seconds to write a quality and complete note," Feinberg said.
Sandy English, RN, OCN, has worked at Georgia Cancer Specialists for 15 years. She can remember when nurses received handwritten orders from doctors, looked up the treatment regimen, created an order and then looked up information to educate patients. Now, she turns to www.chemoorders.com, which uses established peer-reviewed and evidence-based guidelines to ensure that the most current disease protocols are used.
Nurses enter the patient's height, weight and age, lab results, type of tumor, location of the tumor, stage of the tumor and other factors to get results.
"You hit a button and out prints a summary of the regimen, chemotherapy orders and flow sheets, a patient consent form, information on all the drugs and their side effects, and alerts about drug interactions," English said. "There's no handwritten order, so you don't have to worry about a decimal point being in the wrong place. You can ask for reference information and know you can trust it."
The site increases efficiency and decreases prescription mistakes and administration errors.
"It's nurse-driven and [it's] logical," English said. "I love taking care of cancer patients, and this [program] frees up more time to be with them.
"The site is also a great education tool. Patients love the information we provide."
Because the program has worked so well, Feinberg wanted to make it available to other oncology practices.
"We had built a better mousetrap, but since it was a customization built on NextGen's platform, we couldn't sell it," he said. "We decided to do the right thing and turn it into a free Web site."
Feinberg and English introduced the site at the Oncology Nursing Society convention in Las Vegas last May and got positive feedback.
"We don't advertise. Nurses and doctors hear about it word-of-mouth and they use it from all over the world," Feinberg said.
One problem he didn't anticipate was the development costs to maintain the site and keep it current. Running a Web site isn't part of Georgia Cancer Specialists' central mission.
Feinberg hopes that an organization will see the site's potential for improving cancer care and will support it with a grant. The practice is also looking at other funding measures.
"Nurses, pharmacists and physicians all love it and want to know when it can do more," Feinberg said. "Helping to improve the process has been very rewarding."
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