Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients

Abstract

Atsuko Sugiyama,1– 3 Hayato Okumiya,1 Katsuhiko Fujimoto,1 Kazuki Utsunomiya,1 Yuka Shimomura,2 Masaru Sanuki,4 Keitaro Kume,4 Takahiro Yano,4 Rina Kagawa,5 Hiroko Bando6 1R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan; 2Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan; 3Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan; 4Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; 5Department of Biomedical Informatics and Management, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan; 6Department of Breast-Thyroid-Endocrine Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JapanCorrespondence: Atsuko Sugiyama, R&D Planning Office, Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi-ken, 324-8550, Japan, Tel [phone], Fax [phone], Email [email protected]: The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care.Patients and Methods: We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients’ care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented.Results: The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors’ notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals’ viewpoints.Conclusion: The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals’ medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.Plain Language Summary: An important paradigm shift within healthcare is the shift toward patient-centered care and away from disease-centered treatment. Patient-centered care is based on shared decision-making, respecting an individual patient’s preferences, needs and values, and considering social context and best available research evidence to improve the quality of care. A multidisciplinary team (MDT) approach plays an important role in patient-centered care and MDTs are already adopted into daily oncology practices in many countries, especially in breast cancer care. Previous studies have shown that an effective MDT needs more patient-centered information but often that patient-centered information is notably absent from medical records.We investigated if and how patient-centered information such as psychosocial entries exists in patient records. For this purpose, we performed an exploratory pilot study in which the patient records of three patients with breast cancer, including two patients with advanced stage disease, were studied throughout their care pathway. We observed that the documentation of patient-centered information was fragmented and scattered across various medical records written by multidisciplinary professionals. Moreover, these pieces of scattered information were recorded from different perspectives and viewpoints. Our findings point to a significant role that healthcare informatics could play, as integrating the various healthcare professionals’ electronic health record could likely produce multifaceted and more holistic patient-centered information which could be shared and used in shared decision-making and MDTs with a view to considering both patient and clinical perspectives, potentially improving the quality of care.Keywords: breast cancer multidisciplinary team, breast cancer care, patient-centered care, shared decision-making, patient perspectives, psychosocial information

Keywords

• breast cancer multidisciplinary team
• breast cancer care
• patient-centered care
• shared decision making
• patient perspectives
• psychosocial information