Ascension Borgess Cancer Center in Kalamazoo, Michigan, went live with the Carevive platform on February 23, 2022. Carevive’s Kristen Dininno, RN and Christina Morgan, APRN, MSN-BC, sat down with Elizabeth Coleman, RN, BSN, OCN, Nurse Manager, Ascension Borgess Cancer Center, to chat about what Ascension hopes to gain from using Carevive’s cancer care management tools.
Can you tell us more about the vision behind deciding to implement Carevive in your Medical Oncology department?
We are trying to capture patient needs prophylactically and earlier in their cancer journey. We also recently moved to a new EMR system, so we thought this was a good time to implement impactful changes that will enhance the support given to our oncology patients. From both a clinician and patient standpoint, a big complaint we have been hearing is the lack of an effective portal through which patients can communicate with nurses in a timely manner. We are hoping to manage some of those complaints and issues with the use of Carevive.
Where did you get the idea to implement ePROs to further address patient symptom management needs? How do you think this platform will allow your clinicians to be more proactive versus reactive with their patients? Do you feel this approach will allow for earlier detection of patients in need of services (i.e., palliative care, pain management, social work) that can be offered at Ascension?
This platform [Carevive] was brought to me personally by Adam Davis, our Director of Oncology Operations. Previous to Adam’s exposure, we were not aware that remote symptom management and monitoring was an option. We are very happy to have this available as an option now. In our oncology clinic, we want to promote quality of life and ensure patients are feeling the best they can at home. With Carevive, the interactive and automated education that is available will be so great for both patients and their families. We feel that this platform will also benefit those individuals needing additional services, such as palliative care and social work.
How will the use of the Carevive platform differ from what you are currently offering oncology patients today?
As of now, we are providing chemo education by Lexicomp and/or Chemocare, and manually answering symptom-related phone calls via our triage line. We are hoping that by educating patients about Carevive and enrolling them, we will be able to further address and manage symptoms sooner. Patients will be able to report in real-time the symptoms they are experiencing throughout treatment, providing an opportunity for our nurses to respond quickly and efficiently. One of our oncology nurses, Kelli, liked that the Carevive treatment care plans are very specific to a patient’s diagnosis, staging, and treatment regimen, and I agree that is a great feature that can be used during education visits. The live website links that provide patients with side-effect profiles and other medication information in addition to what is already being provided today, will be very helpful.
What are the specific goals/metrics you are targeting as an organization by implementing Carevive?
There hasn’t been a lot of useful baseline data that we have collected as an organization around incoming patient phone calls, tracking logs, hospitalizations related to symptom management, etc. Our top goals with use of Carevive include increased patient satisfaction with their clinical team, especially as our portal has been challenging and not a great way to communicate up to this point. Hopefully, reducing symptom-management=related call volumes that currently bog down our nursing staff will also be an important factor that we can measure over time. A few additional goals and metrics we would like to target include:
- improved care coordination for patients;
- earlier detection of needs for referral services;
- tracking oncology-related ER/hospital visits (asking things like, “Have you been to the hospital recently?” or “Have you had to go to an urgent care in the past week?”) as they fill out their weekly surveys. As we start to collect data such as this, we can then review it together as a team. We can look at things like, how many treatment care plans were delivered to patients, what is our volume of moderate to severe alerts that are proactively being managed, etc. It will be interesting to identify the different variables and to see how receptive patients are to this process.
We understand that Ascension Borgess is expanding the oncology program and looking for ways to better support providers and clinical staff through streamlined processes and standardized tools. How can Carevive help you achieve this?
We are looking forward to the integration between Cerner and Carevive. We are new to the Cerner EMR, so we are still struggling to navigate that piece. We like the idea that nurses will not have to duplicate their charting efforts. Patients will receive targeted and up-to-date literature to read on their reported symptoms, even if they are mild, which will be extremely helpful. We also feel the auto-generated triage protocols will be of benefit. Patients will receive baseline information on how to manage their moderate-to-severe symptoms while, at the same time, Kelli and our other nurses are talking with physicians about how to appropriately respond to patient needs. Kelli also mentioned how useful the Carevive content is, ensuring the most up-to-date literature is presented, keeping in alignment with NCCN guidelines, and how everything from Lexicomp and Chemocare is all right there. All of that will benefit our patient population too.
You’ve mentioned that improving the patient care experience and enhancing patient/provider communication is a driver behind implementing Carevive. How can Carevive help you achieve this?
Improving the patient experience is our main goal for implementing Carevive, but enhancing the patient/provider experience is also important. The ability for patients to report symptoms from home will help with that. With our current model, we have three physicians and four Advance Practice Providers, and patients often get frustrated that they haven’t seen their MD in a couple of visits, for example. The Carevive dashboard will allow patients to have more open communication with the entire clinical team, regardless of the provider they are seeing at a particular visit. Also, any practitioner in the clinic can access Carevive directly from Cerner and review symptoms reported by patients during those visits, so there is full transparency into the symptom experience. This also will help patients feel like they are heard and have a voice in their care, not having to explain what they are experiencing or tell the same story over and over to multiple clinicians. The Carevive platform provides a way to easily track symptoms, communication, and treatment care plan needs, which results in everyone’s time being utilized in a more efficient and valuable way. Patients will feel they are listened to and are on track to get what they need. This will be a good platform to improve communication overall within the facility.
Given your positive feedback from what you’ve seen Carevive can offer so far, what other departments would you like to see this expand to within your institute and beyond?
We have satellite locations, Allegan and Dowagiac, which are smaller clinics with lower staff volume. Carevive may provide an opportunity for them to have greater productivity within their nursing hours and allow for better response times to acknowledge symptom management needs by not having to wait until the end of every shift to check voicemails and make callbacks. The nurses at these facilities are face-to-face, providing direct patient care and administering chemotherapy. Oftentimes they are getting to the symptom calls at the very end of the day. Palliative care is also housed here at our location, and the palliative care team sees patients within their own department. Carevive could be beneficial for them as well, which is why Adam has previously connected you with their director. We also have an in-house social worker and dietitian that we feel could be included in the use of the platform.”
Kristen Dininno, RN
Sr. Account Manager
Christina Morgan, APRN, MSN-BC
Clinical Practice Transformation Advisor