Location

2023 Providence Nursing Research Conference

Start Date

24-2-2023 3:00 PM

Keywords:

washington; spokane

Description

Background: Oncology navigation programs have evolved to include services for addressing cancer care barriers, focusing on care coordination, patient experience, and care value, and may include nurses, social workers, and non-licensed trained workers as care navigators. The 2023 Enhancing Oncology Payment Model (EOPM) requires navigation services and emphasizes improving care value and outcomes. Effective healthcare navigation and collaboration can improve value by reducing care duplication, missed appointments, and emergency admissions; identifying and addressing health-related social needs; addressing health inequities; and improving time-to-treatment initiation and patient retention. The Institute of Medicine also advocates for healthcare professionals to work interprofessionally, implement quality improvement principles and evidence-based practice, provide patient-centered care, and utilize informatics to improve outcomes. Navigators commonly utilize various non-interoperable tools and processes to manage and track healthcare, including the electronic health record (EHR) and less secure electronic databases, spreadsheets, calendars, and more. Navigators identified a gap in EHR tools for promoting effective collaboration and improving oncology care efficiency within a healthcare interdisciplinary oncology navigation program. Purpose: To describe interprofessional collaboration to enhance the EHR to optimize oncology navigation efficiency. Methods: Following demonstrations of care inefficiency and duplication related to suboptimal EHR tools, informaticists collaborated with interprofessional oncology stakeholders to authorize, build, and implement EHR tools to meet specialized patient navigation needs. Stakeholders, including nurse navigators, social workers, leaders, and informaticists, met virtually to identify gaps and variations among the navigation programs. Common cited challenges included documentation inefficiencies within the EHR, creating barriers to identifying patients, reviewing care delivery data, and tracking relevant patient outcomes. Navigators sought solutions to prioritize and optimize care coordination, improve employee satisfaction, and enhance care outcomes. The interprofessional team created EHR documentation, tracking, and reporting dashboard tools with various analysts. Then, informaticists supported the implementation with virtual training and evaluation sessions and subsequent optimization requests prioritized by a majority vote. Reinforcement teaching sessions supported learner adoption and confidence, with a transition to virtual on-demand informatics teams for ongoing support. Results: Data analytics reveal nearly 60% (61/106) of navigators from 6/7 states use the tools. Navigators’ survey feedback suggest reductions in non-EHR tracking tools, and greater efficiency in identifying and tracking patients; documenting oncology-specific care, navigation acuity, and patient education; measuring time and resource allocation by disease type, and communicating with patients. Navigators also report that new task lists, patient-specific oncology overview indices, productivity reports, and the navigation dashboard enhance efficiency and transparency. Survey results suggest interest in more training about EHR reports, and a desire for future collaboration among navigators and informaticists. Conclusions: Interprofessional collaboration and EHR transformation contribute to the consolidation and optimization of navigation services tools and improve navigation efficiency for improving care value and outcomes. Implications for Practice: The use of enhanced EHR tools better capture navigator-influenced patient outcome metrics and aid in understanding opportunities to enhance care delivery aligned with the EOPM. Suboptimal navigator adoption of the spectrum of EHR tools warrants additional outreach about the tools, data analytics, and reporting functionality

Comments

References:

Academy of Oncology Nurse and Patient Navigators. (2022, August). AONN+ & the American Cancer Society 2020 Navigation Metrics Toolkit. https://www.aonnonline.org/images/resources/navigation_tools/2020-AONN-Navigation-Metrics-Toolkit.pdf

Center for Medicare & Medicaid Services. (2022, June 27). Fact sheet: Enhancing oncology model. https://www.cms.gov/newsroom/fact-sheets/enhancing-oncology-model

Commission on Cancer. (2016). Cancer program standards: Ensuring patient-centered care.

https://www.facs.org/media/t5spw4jo/2016-coc-standards-manual_interactive-pdf.pdf

Franklin, E., Burke, S., Johnston, D., Nevidjon, B., & Booth, L. S. (2022). Oncology navigation standards of professional practice. Navigation, 13(3). https://www.ons.org/pubs/article/245521/download

Institute of Medicine. (2003). Health professions education: A bridge to quality. https://www.ncbi.nlm.nih.gov/books/NBK221528/

Johnston, D., & Strusowski, T. (2018, June). AONN+ evidence-based oncology navigation metrics crosswalk with national oncology standards and indicators. Journal of Oncology Navigation & Survivorship, 9(6). https://www.jons-online.com/issues/2018/june-2018-vol-9-no-6/1852-aonn-evidence-based-oncology-navigation-metrics-crosswalk-with-national-jons-oncology-standards-and-indicators

Silva, J., & Patel, A. (2021). The impact of an electronic health record to advancing nurse navigation using standardized metrics in a healthcare system. Journal of Oncology Navigation and Survivorship, 12(11), 424-425. https://aonnonline.org/categories?view=article&secid=247:november-2021-vol-12-no-11&artid=4168:the-impact-of-an-electronic-health-record-to-advancing-nurse-navigation-using-standardized-metrics-in-a-healthcare-system&catid=57

Strusowski, T., Sein, E., & Johnston, D. (2017). Standardized Evidence-Based Oncology Navigation Metrics for All Models: A Powerful Tool in Assessing the Value and Impact of Navigation Programs. Journal of Oncology Navigation & Survivorship, 8(5). https://www.jons-online.com/issues/2017/may-2017-vol-9-no-5/1623-value-impact-of-navigation-programs

Clinical Institute

Cancer

Department

Nursing

Department

Oncology

Department

Health Information Technology

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Feb 24th, 3:00 PM

Interprofessional Collaboration Optimizes Oncology Navigation Efficiency and Value​

2023 Providence Nursing Research Conference

Background: Oncology navigation programs have evolved to include services for addressing cancer care barriers, focusing on care coordination, patient experience, and care value, and may include nurses, social workers, and non-licensed trained workers as care navigators. The 2023 Enhancing Oncology Payment Model (EOPM) requires navigation services and emphasizes improving care value and outcomes. Effective healthcare navigation and collaboration can improve value by reducing care duplication, missed appointments, and emergency admissions; identifying and addressing health-related social needs; addressing health inequities; and improving time-to-treatment initiation and patient retention. The Institute of Medicine also advocates for healthcare professionals to work interprofessionally, implement quality improvement principles and evidence-based practice, provide patient-centered care, and utilize informatics to improve outcomes. Navigators commonly utilize various non-interoperable tools and processes to manage and track healthcare, including the electronic health record (EHR) and less secure electronic databases, spreadsheets, calendars, and more. Navigators identified a gap in EHR tools for promoting effective collaboration and improving oncology care efficiency within a healthcare interdisciplinary oncology navigation program. Purpose: To describe interprofessional collaboration to enhance the EHR to optimize oncology navigation efficiency. Methods: Following demonstrations of care inefficiency and duplication related to suboptimal EHR tools, informaticists collaborated with interprofessional oncology stakeholders to authorize, build, and implement EHR tools to meet specialized patient navigation needs. Stakeholders, including nurse navigators, social workers, leaders, and informaticists, met virtually to identify gaps and variations among the navigation programs. Common cited challenges included documentation inefficiencies within the EHR, creating barriers to identifying patients, reviewing care delivery data, and tracking relevant patient outcomes. Navigators sought solutions to prioritize and optimize care coordination, improve employee satisfaction, and enhance care outcomes. The interprofessional team created EHR documentation, tracking, and reporting dashboard tools with various analysts. Then, informaticists supported the implementation with virtual training and evaluation sessions and subsequent optimization requests prioritized by a majority vote. Reinforcement teaching sessions supported learner adoption and confidence, with a transition to virtual on-demand informatics teams for ongoing support. Results: Data analytics reveal nearly 60% (61/106) of navigators from 6/7 states use the tools. Navigators’ survey feedback suggest reductions in non-EHR tracking tools, and greater efficiency in identifying and tracking patients; documenting oncology-specific care, navigation acuity, and patient education; measuring time and resource allocation by disease type, and communicating with patients. Navigators also report that new task lists, patient-specific oncology overview indices, productivity reports, and the navigation dashboard enhance efficiency and transparency. Survey results suggest interest in more training about EHR reports, and a desire for future collaboration among navigators and informaticists. Conclusions: Interprofessional collaboration and EHR transformation contribute to the consolidation and optimization of navigation services tools and improve navigation efficiency for improving care value and outcomes. Implications for Practice: The use of enhanced EHR tools better capture navigator-influenced patient outcome metrics and aid in understanding opportunities to enhance care delivery aligned with the EOPM. Suboptimal navigator adoption of the spectrum of EHR tools warrants additional outreach about the tools, data analytics, and reporting functionality