Founded at the Abramson Cancer Center at the University of Pennsylvania

Embedding Cancer Clinical Pathways in the Electronic Health Record for Value-Based Care

Cancer Clinical Pathways


Clinical pathways help to reduce variation in cancer treatment and care, and have been shown to reduce costs as well as improve patient outcomes. In spite of this, they are underutilized. There are many explanations for this; looking at Penn Medicine specifically, clinical pathways exist outside of the electronic health record (EHR), resulting in burdensome manual data entry and difficulty measuring pathway adherence.

Through a pilot project within Penn’s thoracic oncology practice, Flatiron AssistTM will be implemented as a clinical pathway tool into the existing EHR and will prompt clinicians with treatment recommendations concordant with National Comprehensive Cancer Network (NCCN) guidelines. Additionally, the integration of Flatiron AssistTM into the EHR will enable clinicians to use it efficiently in real-time to inform and make treatment recommendations, and will be directly linked to the ordering of therapies. While the current system of clinical pathways at Penn are NCCN concordant, they do not include clinical trial recommendations–something Flatiron AssistTM will prompt.

The aims of the pilot are threefold: (1) to implement the tool across all 13 Penn Medicine thoracic medical oncology outpatient practices and measure its usage; (2) measure concordance of ordered treatment regimens with NCCN guidelines and with Penn pathways; and (3) measure treatment variation among providers by clinical scenario. Medical oncologist champions across Penn Medicine will facilitate uptake and obtain feedback to inform subsequent iterations of the intervention.

The degree of integration into the EHR sets this pilot apart from the use of clinical pathways at other institutions, as does its coalescence of national and local stakeholders including Flatiron Health, NCCN, Penn Medicine leadership, and front-line staff.


Implementation is currently in progress. This intervention has the potential to improve the delivery of evidence-based cancer care.


Lawrence Shulman, MD; Christopher A. D’Avella, MD; Erin Bange, MD; Aditi P. Singh, MD; Charu Aggarwal, MD, MPH; Amy Iarrobino Laughlin, MD


Flatiron Health; Cancer Service Line at Abramson Cancer Center


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