The effects of implementing an electronic medical record on prehabilitation exercise prescription reporting for autologous stem cell transplantation

PURPOSE: This study evaluated the effect of implementating an electronic medical record (EMR) and tailored exercise case report form (CRF) on exercise prescription documentation in a prehabilitation service for patients with cancer prior to autologous stem-cell transplant. Specific aims were to evaluate documentation of exercise parameters - frequency, intensity, time, type (FITT) - and reasons for missing data; and compare findings to a pre-EMR implementation evaluation. METHODS: A retrospective service evaluation using prospectively collected data from February 2023 to February 2024, reported according to STROBE guidelines. The implementation element of the RE-AIM framework was used for evaluation. Data were descriptively compared to a previously published pre-EMR implementation audit. RESULTS: During the 12-month audit period, 115 patients attended prehabilitation initial assessments with an exercise clinician. EMR audit found 88.7% (n = 102/115) of patients were prescribed either resistance, aerobic, or both exercise types, compared to 72.4% (n = 84/116) pre-EMR implementation. Eighty-four percent (n = 97/115) of patients were prescribed an aerobic program. Of these, 91.8% (n = 89/97) had all required FITT exercise prescription parameters documented, compared to 28.7% (n = 27/94) pre-EMR implementation. Of the 80.9% (n = 93/115) of patients prescribed a resistance program, 89.2% (n = 83/93) had all exercise prescription parameters documented in the EMR compared to 0% pre-EMR implementation. For patients not prescribed exercise, 84.6% (n = 11/13) had valid and clearly documented reasons. CONCLUSION: Documentation of exercise prescription was more complete and consistent following implementation of an EMR and CRF. These findings support evidence that EMR implementation can reduce fragmentation, inefficiencies and improve consistent delivery of high-quality cancer care.