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Adverse event collection & tracking in Epic

  • 1.  Adverse event collection & tracking in Epic

    Posted 10-23-2019 19:09
    Colleagues,

    We are working to optimize the use of our EHR (Epic) and veering from traditional research shadow charts. To that end, we are exploring how to shift from paper adverse event logs to utilizing Epic. We have recently tested the recently released features in epic through the research adverse event "form/screen",  the nurse toxicity assessment flowchart and the well established in-basket messaging features. The functionality currently allows: use of CTCAE versions for event terms and grading, serious/non-serious and un/expected designations, start/stop dates and routing to a physician to sign off and/attribute. Sounds like a dream right?

    But we have hit a roadblock:
    1- if the research AE tool is used the events do not flow over to the oncology synopsis protocol and oncologic assessment views so the provider does not have a comprehensive glance of the patient status/summary for management of their care.
    2- if the nurse toxicity assessment flowchart is used instead, there is no ability to document severity, expectedness or attribution
    3- If we solve #1 and #2, we are unable to identify the best way to document what the event is attributable to for protocols involving more than one investigational product (i.e. combination treatment, medicine and radiation, chemo followed by immunotherapy, etc.). Example: not related to chemotherapy possibly related to radiation.

    Essential our goal is for non-licensed clinical research professionals (i.e. coordinators) enter adverse events using the protocol directed CTCAE version, grade objective events, denote expectedness and severity, start/stop dates --> route to the treating physician for review and completion the attribution field for each interventional agent and sign off --> have the list of active events appear in a clinical summary --> have the ability for providers to link these/populate in their progress note.

    Epic tells us some centers have developed workflows for this (I presume they are workarounds or modified use of other features in Epic to facilitate this) We know some of these limitations are in development or under consideration for future software upgrades but the release timelines are unknown. We are eager to learn from the community, if you are an epic user and using epic for adverse event collection and management, would you be willing to speak about your experience?
    Magic wand anyone?

    ​​

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    Therica Miller CCRP, MBA
    Hartford HealthCare
    Hartford, CT
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  • 2.  RE: Adverse event collection & tracking in Epic

    Posted 10-24-2019 08:06
    Hi Therica,

    That really sounds like a dream. We have been working with IT at our site as well to incorporate similar tool in our EHR. We use cerner at our site not Epic. We have CTCAE and grading included in the EHR which auto populates to physician notes but it's lot of time consuming for physicians so we rarely use it. Curious to learn how other sites about electronic documentation of AEs-


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    Ramya Thota MBBS
    Intermountain Healthcare
    Murray, UT
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  • 3.  RE: Adverse event collection & tracking in Epic

    Posted 10-25-2019 13:19

    Therica,

    Oh my, definitely sounds like a dream! We haven't explored this feature, but I would be very interested in joining the conversation around this, as we are also an EPIC user.

    Mind if I take forward to our IT team?

    Do you happen to know if you've talked with EPIC about modifying the functionality?

    Nice work....awesome potential!
    Lora​



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    Lora Black RN, MPH, OCN, CCRP
    Sanford Research
    Sioux Falls, SD
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