EMR App Increases Patient Referrals to the Leukemia & Lymphoma Society

Jessica MacIntyre, DNP, MBA, APRN, NP-C, AOCNP

Free resources provided by the Leukemia & Lymphoma society (LLS) are often not taken advantage of by patients with hematologic malignancies, according to Jessica MacIntyre, DNP, MBA, APRN, NP-C, AOCNP. Therefore, MacIntyre and colleagues developed a Fast Healthcare Interoperability Resources (FHIR)-based app, which was implemented at the point of care via electronic medical records (EMRs) to increase referrals of newly diagnosed patients to LLS.

MacIntyre presented data from the study at the 48th Annual Oncology Nursing Society (ONS) Congress. Findings showed that the use of the FHIR app, which was developed through a collaborative effort of 5 organizations, resulted in 245 referrals to the LLS over the span of 15 months, equating approximately 700 interactions between patients and the LLS. Prior to implementation 10 referrals to the LLS were seen in the past 2 years at Sylvester Comprehensive Cancer Center, which was using paper forms.

“The app not only increased the ease of referring but also enabled tracking of metrics resulting in the ability to track true changes in the number of referrals over time,” MacIntyre said in a presentation of the data. “When looking at the engagement with LLS services among patients referred…patients agreed to support via LLS financial assistance [and] they also were registered for patient education as well as the blood cancer conference.”

In an interview with Oncology Nursing News®, MacIntyre, the executive director of Clinical Operations and an advanced nurse practitioner at the University of Miami Sylvester Comprehensive Cancer Center, described how nurses used the EMR system at Sylvester to refer patients via the FHIR app.

Oncology Nursing News: What background led to the creation of this intervention?

MacIntyre: We found that we have many patients with hematologic malignancies who do not know the resources that are available to them for support after a cancer diagnosis. The background came from looking at how we can better provide these [underused] resources to patients that would help them during their cancer journey.

Trying to [find] an [easier] way to refer patients to LLS was our goal. Since information technology is in the forefront of cancer care now and everyone has an EMR, we thought it might be easier and less burdensome to do an electronic referral through our EMR system.

Please describe the intervention and how it operated.

We developed the workflow using what we thought was the best way to educate patients about the resources available through the LLS and to get the referral to LLS. We used our nurse navigators as the first point of contact [for] any patient with a hematologic malignancy upon first intake of that patient and during that first call, they would introduce the referral [offer] and ask if [patients] would like to be referred to the LLS and all the resources that they provide.

If the patient said yes, [the nurse navigator] would open a form directly from the EMR that would [allow] them to put in the information needed to transmit to the LLS. But the patient would not have that information transmitted until they first checked into their appointment because they must sign a consent [form] to be able to confirm that their information can be shared with a third party. Once they signed that consent then it was transmitted to the LLS, but if the patient refused or if they didn’t sign the consent, then we would have a second call back from our social work team.

[That team] would get a [notification] saying this patient refused the referral or did not sign the consent, can you contact them to confirm that they don’t want the resources, or do at a later point in time. We know patients sometimes are very overwhelmed at that the first point of contact, may not have been aware about the resources, [or] may have forgotten about it. So, we want to make sure we’re able to offer [these resources] at least at a second point in time throughout their cancer journey.

The social worker will contact them and ask, ‘Are you sure you don’t want the referral to LLS?’ If they say [they do], then they can transmit the referral the same way that the nurse navigator did. It’s nice to be able to have those second touch points so that patients are kept informed of the resources that are available to them.

How did you evaluate this intervention and the number of referrals?

We found that it was a much easier process [because] in the past we used to do paper forms [and] fax paper forms to our advocacy groups to refer patients for their services. Now it’s a touch of a button so it’s much easier and we referred a lot more than we used to in reference to the paper format.

We found a huge increase in the number of referrals to the LLS and most [patients] had financial support provided to them by LLS. [It was] nice to see that they’re able to provide not just education and clinical trial eligibility information, but also financial support, conference information, [and information] patients and their caregivers can appreciate and that we probably wouldn’t be able to offer as providers.

The surprising thing I found [was] how easy it was to work with 5 organizations on this. You may think that having so many individuals [with] their hands in the pot, [it would make] it kind of difficult to make something happen, but we worked so well together because we had the goal of giving these resources to patients. We had a purpose, and I think it really worked well because of that. We had so many knowledge and content experts that helped us to integrate [this] into our electronic health system and it was surprising to me to see how well it flowed.

What are the next steps and the greatest challenges?

[For] next steps we’re trying to see how we can have the referral in our navigator pane for our advanced practice providers and our physicians to be able to refer as well. We don’t want to cause more burden on them because we know that EMR burden is real, so we’re trying to make it easy that if they want to refer, they have the ability to on their navigator pane. That’s the next step in trying to integrate that flow into our workflow.

The biggest challenge would be that we used Epic [Systems] as our EMR and not [all practices] have Epic. The challenge will be for us to be able to have other organizations integrate this FHIR app within their EMRs and try to figure out what workflows work best for them. We can have an experience of using our navigators and social workers, but it may not necessarily work for other organizations that don’t have those resources or don’t have the ability to do it in that same fashion.

What are the overall implications of this research for oncology nursing practice?

As an oncology nurse, I always remember how much I looked into [resources] for patients and how much information I provided to patients. The more you know about the resources that you don’t have inside your organization that can help support a patient in an area where you can’t, is really important information.

Getting the word out about the information that other advocacy groups have to offer is important as an oncology nurse [because] then I’m able to help my patients tackle things that maybe we as nurses didn’t think we could. It’s important to know what information is out there and what advocacy groups offer, so you can help your patients with a more holistic approach.

Reference

MacIntyre J, Sae-Hau M, Disare K, Torrents S, Buckta B, and Berkowitz S. Development of an electronic referral to the leukemia & lymphoma society (LLS): enhancing access to patient resources and information. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed May 5, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12560