Using health information technology as a tool for systems change and racial equity in cancer care: Phase I of accure

The Accountability for Cancer Care through Undoing Racism and Equity study is a partnership between communities and health systems to optimize transparency and accountability to achieve racial equity in cancer treatment among patients with early stage breast and lung cancer. Given national emphasis on electronic health records and meaningful use (MU), we are leveraging EHRs for race specific quality reports and development of a real time registry that identifies patients who have missed appointments or have not met expected milestones in timely cancer care. We developed an automated system to perform a retrospective chart review in 2 disparate and complex healthcare systems. The data obtained serves as a baseline for our population based interrupted, time-series analysis and will be used as the substrate for initial race-specific feedback sessions for providers to begin the quality improvement methodology in the study. Transparent data and provider feedback are part of a multi-faceted intervention to narrow gaps in both treatment initiation and completion between White and African-American patients. The programming involved in collecting the retrospective data will be transferable to prospective data acquisitions so changes in care can instantly be assessed over time. The real time electronic registry is the key to the patient-centered tracking process. Imbedded warnings from this system will serve as triggers for discussions and services provided by a navigator trained to identify adherence barriers related to implicit system bias. We will present early results and discuss overcoming MU deficits and using EHRs for improving transparency and care.