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Routine screening for financial hardship may identify patients at risk of financial crisis, such as bankruptcy or inability to afford food or medication and facilitate mitigation of financial toxicity. We describe our implementation of systematic financial hardship screening using the electronic health record (EHR) in an outpatient cancer center in New York City. Our process was developed previously with stakeholder input to screen all breast cancer patients for financial hardship risk using 2 items (Qi and Q3) from the Comprehensive Score for Financial Toxicity. Patients complete the 2 items either through: online patient portal during appointment check-in; or English or Spanish paper form distributed to patients by front desk staff during check-in and entered into the EHR during vital signs assessment. The EHR prompts survey completion again after 1 month. Using descriptive statistics, we evaluate implementation feasibility as the rate of completion; and we describe the financial hardship and worry experienced by respondents. From March to July 2021, 1,109 patients were seen in the breast oncology clinic, 23% were Hispanic/Latino and 14% were Black/African American; the mean age was 58 years (s=14). These patients represented 2,678 clinical encounters with an average of 2.6 visits per patient, and 864 (78%) patients completed at least one assessment using the online portal. There were 1,106 (41%) responses to Q1: "I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment;" and 1,109 (41%) to Q2: "I worry about the financial problems I will have in the future as a result of my illness or treatment." For Qi, 517 (47%) responded "not at all" or "a little bit." For Q2, 455 (34%) responded "quite a bit" or "very much." Our study highlights two findings: first, implementing systematic financial screening in oncology clinics is complex; and second, financial hardship and worry are prevalent and require interventions to mitigate this devastating adverse effect of cancer care. Future research will focus on assessing patient perspectives to improve acceptability of current procedures, and developing interventions and referrals for patients most in need. [ABSTRACT FROM AUTHOR]

EPIC, an electronic medical record (EMR), has the capability for patients to enter their own data through the patient portal, MyChart. However, this function was not utilized. Intake specialists e-mailed paper intake forms, which were returned by fax and scanned into EPIC. The nurse coordinator (NC) also called patients, gathered data by phone, and manually entered it into the EMR. The purpose was to provide patients with an electronic form via MyChart to complete before their visit engaging them to actively participate in their own care. The project workflow was designed to save nursing, administration, and transcription time. An Epic Optimization request was placed to initiate a disease specific fillable form to be added to MyChart for New Patient Intake in the Breast Clinic of Women's Oncology Services. The NC collaborated with the nurse analyst from the EPIC team to develop the form and create a new workflow. They trained the clinical staff on how to access the information and reconcile the medical record. After the electronic forms were developed, the intake staff was trained and a physician champion was identified to pilot the project. A total of 20 female patients participated in the pilot; 13/20 (65%) were diagnosed with breast cancer and 7/20 (35%) had benign breast issues. The age range was from 33-86 with the mean age of 61. A total of 15/20 (75%) completed the two questionnaires. Participants' feedback included ease, speed and simplicity of form completion, and reduction of redundant paperwork. Team member comments revealed major time savings, efficiency, and security of patient information. More nursing time remained to support the patient. After the pilot project was complete, it was presented at breast center leadership and staff meetings. The nurse analyst and NC provided individual and group training for staff. Smart phrases were developed and shared with staff for data input into the EMR. A full roll out was implemented with plans to expand to other disease teams. This workflow fully utilizes the EMR and allows patients to participate in their own care. It ensures that the medical record is accurate, secures patient data, and reduces redundancy. The information can be re-viewed prior to the visit and the process saves valuable nursing time. [ABSTRACT FROM AUTHOR]