Blood cancers

How electronic health records were key to accessing haematology services during pandemic

Integrated electronic healthcare records (EHR) for haematology patients across a metropolitan base and its linked regional centres helped support telemedicine during the first year of the COVID-19 pandemic.

According to an article in The Lancet Haematology, St Vincent’s Hospital Sydney extended its EHR across outreach services in Griffith and Wagga Wagga in 2017.

“This process allowed for safe remote chemotherapy prescribing, clinical monitoring, and multidisciplinary management of patients with haematological conditions,” the article said.

It said the urgent shift to telemedicine at the beginning of the pandemic would have been impossible without the unified EHR.

“The added advantage of the EHR was the ability to monitor service activity and disruptions due to COVID-19,” the authors said.

A review of clinical service activity in the 12 months before and after COVID-related travel restrictions started in April 2020 showed that total patient consultations at both regional sites increased almost 60% after the transition to telemedicine-only patient reviews.

The number of new patients reviewed also increased at both locations after the transition to telemedicine only.

The review found delivery of chemotherapy and supportive treatments was not substantially reduced after the change to telehealth.

“No increase was seen in the number of regional patients with haematological conditions having unplanned admissions to the tertiary referral centre to suggest disruptions in care or serious complications due to treatments delivered in the rural and remote centres,” they said.

“We were able to show that this vulnerable rural and remote high-risk patient group with haematological conditions were appropriately treated and monitored during the COVID-19 pandemic without the need to travel long distances for specialist reviews.”

They said having the unified EHR already in place “mitigated the potentially catastrophic scenario of no access to critical cancer services for 12 months or more.”

“We advocate for the widespread adoption of strategies to integrate medical records of outreach rural and remote cancer services where possible, particularly for management of malignant diagnoses, in which close clinical monitoring between reviews is often required.”

“If the unique needs of this vulnerable patient group are not addressed, we run the risk of widening the gap between rural and remote and metropolitan cancer health outcomes.”

Haematologist Associate Professor Nada Hamad, from St Vincent’s Hospital Sydney, told the limbic that the advocacy for extending EHR access to outreach clinics had to come from the metropolitan side which had the resources to do so.

The Griffith experience, in which St Vincent’s provided access to their MOSAIQ system, has been previously described in the Internal Medicine Journal.

“Access to the EMR is something you can give away. It’s not impossible, it just requires a negotiation and an agreement between area health services and executives to do it.”

She said the only revolutionary part of the process was to suggest it was possible and have the temerity to see it through.

“It took about a year to convince people this was worth doing. It wasn’t hard, it just required a lot of negotiation and explaining what it meant at the end of the day for patients.”

“It really does have to be something that comes from the side that is delivering the service…because people think it is either too hard or they have just never thought about it before.,” she said.

“During COVID it has paid dividends for sure.”

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