This summer, we began a three-part series discussing the challenges of EMR interrogation for patient recruitment to clinical trials. Today, we examine factors that influence the timing of EMR interrogation at the clinical site.
There are complexities that make interrogating the EMR for clinical trial recruitment challenging. Along with three technical challenges mentioned in our last blog (data gaps, lack of data conformity, and lack of data specific to oncology), a new challenge is the necessity of reprioritizing of clinical resources towards acutely ill COVID-19 patients. An unfortunate side effect is that oncology patients, including diagnosed patients and those yet to be diagnosed, lost the option to have substantiative conversations with their care providers about considering clinical trials as a potential treatment path.
Complexities on Top of Complexities
Many complexities exist today that can confound when and how to do EMR interrogation.
Complexity #1: Entering Fall 2020, we see some trials starting up again. The need for patients for trials will only grow exponentially as the backlog of trials previously put on hold or delayed move to the forefront. Finding patients for trials pre-COVID was a challenge, now it is even more so. Traditional methods for identifying and matching patients may be unable to scale up for the new levels of demand. There is only so much time in the day to review charts.
Complexity #2: Resources are scarce. While schedule-based screening may seem logical to address staff shortages, it is important to consider other times to engage patients. For example, is the best time to approach a patient prior to a visit, or prior to their “disease clinic” visit? Having current real-time EMR information quickly available, and comprehensive enough with needed details to make such an assessment, is critical to determine the best timing to approach and engage patients.
Complexity #3: Oncology trials tend to have short recruitment windows. This means finding the right patients at the right time is critical to giving them more options for care and improving their quality of life. This becomes a race against time to identify the right patients for a trial. This is further complicated by a clinical study’s framework and inclusion/exclusion criteria, which can include a combination of stage and biomarker or two (e.g., the presence of PD1 on immune cells) such pieces of data can make all the difference between a patient being included in a trial or not.
Would you be able to find deep patient-level data details quickly and easily currently? Is your EMR even set up to identify such items?
One Way to Overcome the Challenge of Finding Patients? Always Be Searching.
Our work with cancer centers has taught us that recruitment is so complex because so many interacting factors contribute to its success or failure of efforts. As a result, there is no single “right” time to screen for patients. Sites should aim to interrogate EMRs based on the unique needs and characteristics of their healthcare organizations, with the goal of interrogating daily. Finding a solution that can automate the process and perform nightly screening is optimal. This is where limited resources can be mitigated.
So, after considering complexities on top of complexities, what is the best way to manage all these tasks, still see patients, still screen patients to trials, and keep your sanity?
Our final post in this series, “Tools Available for EMR Interrogation and How Best to Evaluate Them,” will outline ways that Inteliquet™ has accomplished this. For one Cancer Center in particular, our efforts allowed them to improve their workflow around the task of completing feasibility survey questionnaires.