Tension between timeliness and completeness of data in the initiation of cancer treatment: A qualitative study of oncology practice workflows and enduring health IT challenges.

Introduction: Diagnostic evaluation and treatment planning for newly diagnosed cancer requires a coordinated effort across multiple specialties. Delays in treatment initiation are common, leading to unnecessary anxiety and decreased survival. Given that timely treatment initiation is pivotal to providing high quality cancer care, we sought to characterize patient intake, workflows, and the role of health information technology (HIT) in a varied group of oncology practices nationwide. Methods: Interviews with oncologists were performed between March and September 2016, with follow-ups conducted between October and December 2021. Thematic analysis was used to assign codes to key elements of the transcripts, group these codes into conceptually distinct and clinically meaningful categories, and identify major cross-cutting themes. Results: Nine oncologists participated in an initial interview (one surgical, two radiation, six medical oncology). Four oncologists participated in a follow-up interview (one radiation, three medical oncology). In both time periods there was tremendous variation in staff roles and communication processes; some oncology practices obtained diagnostic studies before the first oncology consult visit, whereas others waited until after the initial consult visit to begin the diagnostic evaluation. Variability and tension were noted to arise from deficiencies in HIT, such as lack of interoperability, impaired speed and quality of data collection, cumbersome user interfaces, and variety of data types in oncology care. Oncologists reported only modest improvements in HIT between 2016 and 2021. Conclusion: Assembling data to make a new cancer diagnosis and treatment plan is complex and time-intensive. HIT interoperability remains a quasi-manual process, contributing to preventable treatment delays. Federal policy supporting interoperability provides an opportunity to develop HIT that supports care coordination and patient-centered care, but effective implementation of such tools will be challenging within current workflows.