Connected Cancer Care: Electronic Health Record Communication Networks in Virtual Cancer Care Teams

Cancer care is routinely delivered by diverse teams of healthcare professionals (HCPs) who participate in complex communication and interactions across healthcare settings. The widespread use of electronic health records (EHRs) has changed how care teams communicate, with these changes poorly understood. The association between EHR communication networks—defined as EHR-based information sharing connections among healthcare professionals—and quality of care is unmeasured. This research developed and tested methods for measuring EHR communication networks in virtual care teams and examined the relationship between EHR communication networks and quality of care.

The specific aims of the research were as follows

• Develop and compare methods for measuring EHR communication networks in virtual care teams for breast, colorectal, and non-small cell lung cancer patients.
• Examine associations between EHR communication network structures and patient outcomes, including 30-day re-admissions and emergency department (ED) visits, 1-year utilization of inpatient and ED services, and 1-year mortality.

This research used a retrospective observational design using a patient sample from the Virginia Commonwealth University Massey Cancer Center, a National Cancer Institute designated cancer center. Patient care uses a multidisciplinary approach, combining the expertise of numerous HCPs, allowing for highly coordinated care. The cohort for this research included Medicare patients who received all or part of their first course of cancer treatment at Massey for breast, colorectal, or non-small cell lung cancer, diagnosed between 2012 and 2017. Data came from three sources: 1) the Massey Data Analysis System, 2) EHR access logs, and 3) Medicare Claims data. Specifically, data on patient demographics, diagnosis, treatment, comorbidity, mortality, and utilization of inpatient and outpatient services after cancer diagnosis, along with time-stamped HCP access to the EHR, were extracted.

The team conducted social network analysis by adapting and testing existing methods to measure temporal relationships. The researchers then examined the association between EHR communication network structures and patient outcomes, including the impact of care complexity on survival time and ED visits. It was found that the greater the complexity of care, the shorter the survival time and the greater the number of ED visits. The researchers found that EHR communication networks mediated the impact of care complexity on survival time but found no evidence that they mediated the impact of care complexity on ED visits. This mediation effect suggests that these communication networks could be further enhanced to impact survival time. The researchers will be expanding this research to a multisite study design and work toward developing an intervention to improve EHR communication in cancer care.