It’s estimated that between 30% and 60% of Ontario cancer patients receive some form of chemotherapy. Systemic treatment (chemotherapy) is complex to manage and has a narrow therapeutic range: if the dosage is too low the patient will not get the benefits of the treatment; if the dosage is too high it may be toxic and potentially fatal. Yet despite this complexity in cancer care, chemotherapy and other systemic therapies are largely managed by paper-based systems. These paper-based systems are more vulnerable to errors - including fatal errors - than electronic systems.
Cancer Care Ontario has put the province of Ontario in the forefront of using electronic technologies to reduce the likelihood of prescribing errors through the implementation of a computerized physician order entry system (CPOE).
Working in conjunction with clinicians, Cancer Care Ontario developed a CPOE system unique to the cancer setting, called the Oncology Patient Information System or "OPIS." This CPOE for oncology eliminates the scenario where a harmful drug error can occur because of incorrect reading of handwriting or incorrect calculation of dosage. CPOE/OPIS also flags drug allergies, drug-drug interactions, or drug-disease interactions when medications are ordered, thus assisting clinicians in making the most appropriate clinical decisions at the point of care.
The CPOE Program at CCO works to develop, maintain and implement the OPIS system at hospitals delivering chemotherapy across Ontario. The program has achieved an unprecedented 100% physician adoption rate. No other jurisdiction in Canada has successfully used electronic health record technologies to achieve this level of CPOE adoption; it is the most fully-automated, broadly-used, cancer-specific drug ordering system in Canada.
Benefits
Computerized drug ordering systems have been shown to reduce drug prescription errors by 18% to 32%. 2 Errors can occur at any point from when a physician writes a prescription through to the pharmacist filling the order (e.g., wrong drug and/or dose prescribed or dispensed). Drug ordering software that both alerts the physician/pharmacist to possible prescribing problems and electronically transmits the order to a pharmacy can prevent these types of medical errors. CPOE programs such as OPIS provide several benefits to care providers that ensure patients receive the safest and most efficient cancer care available. The following table highlights some of these benefits.
CPOE Benefits (by Care Provider Group)
| Physicians: |
Pharmacists: |
- Proven adoption (system is fast and easy to use)
- Eliminates/reduces common medication errors
- Provides clinical decision support at the point of care
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- Provides standardized, innovative therapy regimens
- Ensures orders are received in real-time
- Provides automatic claims processing
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| Nurses: |
Patients: |
- e-MAR (Electronic Medication Administration Record) allows for real time charting of patient information
- Provides interactive alerts for clinician decision support
- Flexible to suit nurses’ unique workflow needs
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- Reduces order-to-patient time
- Reduces adverse events
- Decreases morbidity and mortality
- Patients receive the right drug, right dose, right route at the right time
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Sites Currently Using OPIS
- William Osler Health Centre
- Princess Margaret Hospital
- Odette Cancer Centre, Sunnybrook Health Sciences Centre
- Windsor Regional Cancer Centre
- Juravinski Cancer Centre, Hamilton Health Sciences
- London Regional Cancer Program
- Ottawa Hospital Regional Cancer Centre
- North East Ontario Regional Cancer Centre
- Regional Cancer Care North West
- Grand River Regional Cancer Centre
- Regional Cancer Centre of Southeastern Ontario
- Southlake Regional Health Centre
- Royal Victoria Hospital
- North York General Hospital
- Quinte Health Care
By the Numbers (Quick Facts)
OPIS is currently:
- Deployed in 12 out of Ontario’s 14 Local Health Integration Networks (LHINs)
- Used by over 500 oncologists in 13 regional cancer centres across Ontario
- Used for approximately 65% of all chemotherapy treatments for over 20,000 patients
- Used to prescribe over 50% of all drugs ordered through Ontario's New Drug Funding Program
Plans for the Future
The CPOE Program continues to work toward its mandate of implementing CPOE solutions in all of the province’s health care settings where chemotherapy is delivered. The Program also works to support the delivery of best practices, improve quality of care, improve patient safety, and utilize data to improve accountability and enable better system planning and policy-making.
2 Tamblyn R, Huang A, Perreault R, Jaques A, Roy D, Hanley J, McLeod P, Laprise R. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 2003; 169:549-55.
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