Cure Collaboration

Patient data is streamlined at this national cancer research center.

Half of all families who have endured some form of cancer say they experienced problems related to coordinating care during the course of treatment. One in five participants in a November 2006 survey said they received duplicate tests or diagnostic procedures, or said they were confused about medications their doctors prescribed. Others reported that medical records didn’t reach a doctor’s office in time for an appointment.

“Clearly, a top priority for improving cancer care in this country is fixing this problem,” says Robert J. Blendon, professor of health policy and political analysis at the Harvard School of Public Heath, which authored the study of 930 adults affected by cancer in partnership with the Kaiser Family Foundation and USA Today.

With the help of his IT staff, Lynn H. Vogel, vice president and CIO at The University of Texas M.D. Anderson Cancer Center in Houston, is making great strides in coordinating patient care with a Web-services- based electronic medical records (EMR) system that brings a patient’s clinical and research data, as well as medical images, to bedside PCs.

“In cancer [treatment], the worlds of research and clinical care are so closely tied together,” Vogel says. “Our philosophy is that every piece of data that our patient generates, whether it’s research data or clinical data, should be part of their EMR.”

What makes the system unique is its service-oriented architecture (SOA), which allows more than a dozen departments to use their own best-of-breed processes and software. Each program is wrapped with a services layer, and they collectively form a “virtual data repository” that is accessible to clinicians for viewing or interactive use.

The center’s first EMR project, ClinicStation, integrates a clinician’s access to both images and clinical data for each patient. On the research side, the Clinical Research Information Suite of applications includes an institutional tissue bank, a model for the collection of research data on patients and a data repository that has been built on a research data model for cancer research.

When the project began in 2000, no commercially available EMR system could combine both images and data, let alone do so in an SOA environment. That’s largely still true today, says Deborah Kohn, principal at Dak Systems Consulting, a health care IT advisory firm in San Mateo, Calif.

“The vendors who are out there have been developing systems for years. These companies have invested millions in client/server technology, and tons of customers are totally invested in the technology,” Kohn says. So existing vendors are unlikely to convert to an SOA, though many have added some Web features to their front ends, she adds.

Dr. Kevin McEnery, the visionary behind M.D. Anderson’s EMR system, hatched the idea for an all-inclusive system in 2000 when he was an assistant professor of radiology.

“We were creating too much paper and couldn’t keep up. So we began to look at a better way to present clinical information to the radiologist,” says McEnery, who is now professor of radiology and deputy division head for informatics in the center’s diagnostic imaging division. “Initially, it was just radiology reports. Then I decided that I also wanted, as a radiologist, lab data and clinical notes. So we obtained those from other systems. Clinicians began to ask for the same program in the hospital. So we began working with the central IT organization, and we made that happen in March 2001,” with ClinicStation.

“We accessed the reports directly from the source system using Web services to initially get access to the data,” says McEnery. “We’ve been able to expand that model to include 30 different sources of data that are currently being used by the system.”

The next challenge was to ensure that the system was robust enough to handle an expanding user base, which quickly grew from several hundred to several thousand.

Vogel credits Chuck Suitor, director of EMR development and support, for envisioning early on a three-tiered architecture with multiple servers in the midtier. Today, the system routinely documents 3,000 concurrent users who look at 1.5 million electronic patient records each month.

“When they stop discovering new things about cancer or new ways to treat patients, maybe we’ll have a stable environment,” says Vogel. “Until then, things are changing almost constantly, and we will continue to change to keep up with it.”

Collett is a Computerworld contributing writer. Contact her at

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