How Are You Supporting Survivors Through EMR-Integrated Survivorship Care Plans?

September 04, 2018 by Chris Pirschel ONS Staff Writer/Producer

As reported to Chris Pirschel by Meredith Maheu, BSN, ONC, CMSRN, OCN®

meredith maheu
Meredith Maheu, BSN, ONC, CMSRN, OCN®, is a professional development specialist for the Northwestern Medicine Kishwaukee Hospital Cancer Center in DeKalb, IL.

Incorporating survivorship care plans into a hospital’s electronic medical records (EMRs) can be a tremendous aid for oncology nurses supporting their patients entering survivorship. Using the National Comprehensive Cancer Network (NCCN) treatment guidelines as a template for care, the oncology team can prepare a patient’s medical record with the necessary individualized information. 

Standardizing care plans and building on the NCCN guidelines can help keep the entire medical team informed about a patient’s trajectory through treatment, survivorship, and beyond. EMR-supported care plans can follow patients from their inpatient settings to their family care providers. If a family doctor is unfamiliar with an oncology survivorship plan, the EMR tailors the information to be visible in another part of the patient’s records. Then, if a patient is due for a follow-up exam or screening for cancer, the family care provider can see and order the necessary tests. It works to put everyone on the same page and prevents losing different components of care that are vital to a patient’s survivorship.

Considering the amount of information patients with cancer receive, having a survivorship care plan is crucial to ensure that follow-up visits and warning signs for late effects aren’t missed. EMR-integrated survivorship care plans can act as a roadmap to help providers and patients understand the next steps as the survivorship journey begins. 

When building a survivorship care plan into an EMR, NCCN is a great place to start to tailor it to survivors’ personal needs. However, having the flexibility to adjust and change the care plan is also paramount to ensuring a positive experience for patients. At times, patients may find resources on their own that differ slightly from NCCN guidelines, and that can be great. The information they present could make sense for their situation, and being able to edit the platform and add those details can be extremely helpful. Moreover, it provides an opportunity for oncology nurses to assess existing care plans and add new assessments, tests, or information that could benefit future survivors in a similar situation.

Ultimately, the onus isn’t solely on oncology nurses to support their patients through survivorship care plans. Opening lines of dialogue throughout the care team can help foster interprofessional collaboration. By involving all stakeholders in the process, it’s possible to create well-rounded, comprehensive survivorship care plans for patients. And it’s important not to forget to include patients themselves. Involving them in the discussion can help answer their questions and provide them with crucial information as they begin to face survivorship and living beyond cancer.


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