Navigation programs come in many shapes and sizes, but despite their differences, most navigators agree that tracking workflow and metrics through the electronic medical record (EMR) can give a cancer navigation program an edge, regardless of the size of the program, the type of EMR used, or the degree of technological savvy possessed by the people using it.
At the AONN+ Virtual Midyear Conference, Jessica MacIntyre, APRN, NP-C, AOCNP, executive director of clinical operations at University of Miami Sylvester Comprehensive Cancer Center, Zilipah Cruz, RN, MSN, OCN, director for cancer navigators at Ballad Health Care Center in Northeast Tennessee and Southwest Virginia, and Christina Payne, RN, MSN, OCN, ambulatory oncology nurse manager of navigation and survivorship at UC Health in southern Colorado, shared their personal expertise in administering programs that have adopted EMR systems.
Utilizing a Q&A format led by Ms MacIntyre, the panelists discussed their personal experience using the EMR to track navigation workflow and metrics and touched on some of the major challenges, successes, and complexities involved in leveraging technology to enhance navigator workflow.
When Did You Identify a Need for a Customized Workflow in the EMR?
According to Ms Cruz, the need for a customized workflow in the EMR came about when she inherited a navigation program from another large health system.
“One health system was on 4 different EMRs, where the other health system was on 1 EMR, so we identified the need for standardization,” she said. “We needed to come together to identify 1 EMR—and then customize a workflow once we had the same EMR—across 8 different cancer centers.”
Ms MacIntyre and her team identified the need when they saw their nurse navigators trying to skim through schedules to assure that they weren’t missing any patients. “They were having a lot of work inefficiencies,” she said. “We also saw a need when it came to tracking metrics and stats, because they were working off of 2 systems: one where they entered information, and the other where they documented patient information.”
Based on these observations, they worked with their IT team to integrate all of those data into 1 EMR. “We also had a lot of need from the accreditation side, in terms of keeping metrics,” she said. “So we justified the need and we went forward with our integration.”
What Were the Successes and Challenges to Integrating the EMR?
Ms Payne cited standardized documentation, as well as successful data collection and metrics, as their biggest successes to integration.
“The challenge is getting those reports built, because if it’s not documented correctly, we won’t be able to pull that data,” she said. “Across our organization and throughout Colorado, we have 35 oncology nurse navigators, and getting everybody on the same page in terms of what’s needed for our documentation isn’t easy either. It took a long time to try to make sure everybody was happy with the outcome.”
According to Ms Cruz, “our patient navigators were highly bought into the process because they were tired of their spreadsheets, but as for the nurse navigators, I’m still working on them.”
She cited working with multiple EMRs (before consolidating to 1 EMR) as their biggest challenge. “Because how much standardization can we do until we all have the same EMR?” she noted. Even now that they are finally all on the same EMR, continued standardization remains a challenge, as well as gaining buy-in from cancer center stakeholders regarding the importance of standardization, she said.
Ms MacIntyre agreed that switching from a paper perspective to an electronic perspective was challenging for many of her navigators. “Some people were very comfortable with the way we were doing things, so I think shifting that culture was the biggest challenge that we faced,” she noted. “Another challenge for them was having to rethink how they organize their day based on the new workflows that we integrated within the EMR.”
However, consolidating and standardizing their work significantly improved efficiency, and these data can now be used to justify additional navigation positions. “I think those were the biggest successes that we had,” she said.
What Have Been the Benefits and Challenges of Being Able to Track Metrics?
According to Ms Payne, through the EMR they’re now able to track metrics like timeliness of care, patient caseloads, common barriers and interventions, and how much time navigators spend with each patient.
“But again, the challenge is getting everybody to document that information,” she said. “Navigators are often in a hurry and aren’t always as efficient as they could be in their charting. So we’re working on that as an organization.”
According to Ms Cruz, one of the biggest benefits for her team was being able to demonstrate the need for new navigation positions, as well as being able to show those who are funding navigation and patient assistance programs what barriers (and interventions) exist, and how those equate into metrics.
“In addition, though, challenges have been standardization, standardization, standardization,” she added.
Ms MacIntyre pointed out the need to identify—from the beginning—exactly what an organization is looking for to be able to efficiently capture metrics.
“I think that’s definitely a challenge for all navigation programs,” she said. “Not only using the metrics AONN+ provides—that are important to showing value—but also knowing specifically what your organization is looking for in order to demonstrate the value of navigation.”
She also noted the importance of navigators saying no when they need to.
“Navigation is looked to for a lot of things, so we end up doing metrics for everything, because people think, ‘oh, the navigator can do it. They can get those data for us so that we can justify resources for this program that we want to develop,’” she said. “Navigators do feel a lot of pressure to be able to collect everything, but this overwhelms our teams, so we need to be able to say no when we can.”
Ms Payne added that “measuring too much” makes the metrics lose their meaning. “Then you need to start measuring team member satisfaction, burnout, and retention, because you’re doing so much to your team,” she said.
From the standpoint of accreditation, Ms MacIntyre emphasized that having metrics within the EMR has streamlined reporting as well as process improvement efforts.
“It goes 2 ways: it can be a good thing and it can be a bad thing,” she said. “But overall, I think it’s great to be able to see the information, and be able to utilize it in many different ways.
