The Short Answer
Choose the oncology EHR that handles the work that's unique to cancer care. That means infusion documentation, lab results in front of nurses before treatment, chemo billing that starts from the dose given, correct JW and JZ drug waste modifiers, and strong security.
The fastest way to compare vendors is to ask every one of them the same eight questions below, and have them show you each answer in the software. We built this checklist from the problems Northstar was designed to solve, and we encourage you to use it with every vendor you evaluate, including us.
The Main Oncology EHR Options
Oncology practices usually choose between oncology-specific EHRs and the oncology modules of hospital-wide systems. Independent research firm KLAS found that Ontada (McKesson) and Flatiron Health mainly serve community oncology centers and outpatient clinics.1
| Product | Company | Commonly used by |
|---|---|---|
| OncoEMR | Flatiron Health | Community oncology practices1 |
| iKnowMed | Ontada (McKesson) | Community oncology practices1 |
| PowerChart Oncology | Oracle Health (Cerner) | Hospital and health-system cancer programs1 |
| Medical and radiation oncology systems | Elekta, Varian | Programs with radiation oncology1 |
| Northstar | Catalyst 3 | Oncology practices |
1. How Does It Handle Infusion Documentation?
Ask to see a nurse record a chemotherapy administration from start to finish. In an oncology EHR, infusion nurses should document what was given in a medication administration record (MAR). That should happen in the same chart where they can see the provider's orders and the latest lab results.
Watch for double entry. If what the nurse documents doesn't flow into billing, someone has to re-key it later, and every re-key is a chance for error.
How Northstar answers: infusion nurses document in the MAR, with orders and lab results in view, and the documented dose and vial carry straight into charge preparation. See Chemo & Infusion.
2. Does Billing Start From the Dose Given?
Chemotherapy drugs are billed in HCPCS units, and the units have to match the dose that was administered. Ask each vendor whether billing units are calculated from the documented dose or typed in by hand. Also ask whether the drug's NDC (the code for the exact product used) is matched to its HCPCS billing code.
How Northstar answers: HCPCS billing units are worked out from the documented dose, and an NDC to HCPCS crosswalk matches the drug product used to its billing code. See how.
3. Does It Apply JW and JZ Waste Modifiers Correctly?
JW and JZ are Medicare modifiers for drugs from single-dose containers: JW reports the amount discarded, and JZ attests that none was. According to CMS, JW has been required since January 1, 2017, and JZ since July 1, 2023. Since October 1, 2023, Medicare has returned claims for these drugs as unprocessable when the required modifier is missing.2
Ask each vendor where the waste amount comes from. The safest answer is the nurse's own documentation of the dose and vial, not a separate manual step.
How Northstar answers: JW or JZ is applied from the dose and vial the nurse documented, so the modifier matches the chart. Read more.
4. Will Lab Results Be in Front of Nurses Before Treatment?
In oncology, treatment often depends on the latest results. Ask to see where lab orders go, how results come back into the chart, and whether the infusion nurse sees them on the same screen used to document treatment.
How Northstar answers: lab staff work from the provider's orders. Results that come back are visible in the patient's chart to the provider and the infusion nurses who need them before treatment. See the Lab.
5. How Are Billing Exceptions and Claim Follow-Up Handled?
Good billing software does the groundwork and leaves the decisions to people. Ask how unusual charges are flagged, who reviews them, and where claims that need attention are tracked. Also ask whether codes are checked against their status in the Medicare Physician Fee Schedule.3
How Northstar answers: charges are prepared from documented care, and exceptions go to your billing staff for review. Codes are checked against Medicare Physician Fee Schedule status, and claims that need attention sit in one follow-up queue. See Billing.
6. What Security Safeguards Are Built In?
Every oncology EHR holds sensitive patient information, so ask for specifics, not slogans. Useful questions: Is multi-factor authentication required on every staff login? Is activity written to an audit log that can't be edited? Is chart access controlled per patient and by role? Are sessions encrypted? Is there an extra check before sensitive areas, such as financial dashboards?
How Northstar answers: Northstar is built with HIPAA safeguards. They include multi-factor sign-in on every staff login, an append-only audit log, per-patient chart access, role-based permissions, encrypted sessions, and a step-up check before the executive dashboard. See Security.
7. Will the Vendor Sign a Business Associate Agreement?
Under HIPAA, a vendor that creates, receives, maintains or transmits protected health information on a practice's behalf is generally a business associate. HHS describes the business associate agreement that has to be in place.4 Ask every vendor about their business associate agreement early in your evaluation, and have your attorney review it.
How to ask us: bring it up on your walkthrough, and we'll go through it with you.
8. What Do Implementation and Getting Your Data Look Like?
Switching EHRs is a big project. Ask each vendor how training works for each role, from the front desk to infusion nurses and billers. Ask what happens to your historical data, and how you would get your data out if you ever left. Ask for a realistic timeline for a practice like yours, not a best case.
How to ask us: these depend on your practice and current systems, so we answer them person to person. Call (307) 301-4304.
The Oncology EHR Checklist
Print this or bring it to every demo. Ask the vendor to show each item in the software.
| Ask every vendor | Why it matters | Northstar |
|---|---|---|
| Do nurses document infusions in a MAR, with orders and labs in view? | Safer treatment and no re-keying | Yes |
| Are HCPCS units calculated from the dose given? | Units must match what was administered | Yes |
| Are JW and JZ applied from the documented vial? | CMS returns claims missing them2 | Yes |
| Is the NDC matched to the HCPCS code? | The claim should match the product used | Yes |
| Are unusual charges flagged for staff review? | People make the final call | Yes |
| Is there one queue for claim follow-up? | Nothing slips through the cracks | Yes |
| Is MFA required on every staff login? | Protects patient information | Yes |
| Is there an audit log that can't be edited? | A trustworthy record of who did what | Yes |
| Will they sign a business associate agreement? | Required for vendors handling PHI4 | Ask on your walkthrough |
| What do implementation and data export look like? | Avoid surprises after you sign | Ask on your walkthrough |
Frequently Asked Questions
What Is an Oncology EHR?
An oncology EHR is an electronic health record built around cancer care. It handles treatment orders, lab results that must be reviewed before treatment, infusion documentation in a medication administration record (MAR), and billing for chemotherapy drugs, including drug waste reporting.
Is an Oncology EMR the Same as an Oncology EHR?
People often use the terms interchangeably. An EMR (electronic medical record) and an EHR (electronic health record) both refer to the digital patient chart; EHR is the broader term. When you search for oncology EMR software, the questions in this checklist apply the same way.
What Should an Oncology Practice Look for in an EHR?
Start with infusion documentation in a MAR, with orders and lab results visible to the infusion team. Then look for chemo billing that starts from the dose given, JW and JZ waste modifiers, and an NDC to HCPCS crosswalk. Finally, check for an exception and claim follow-up workflow and strong security safeguards, such as multi-factor sign-in and an audit log.
What Are the JW and JZ Modifiers?
JW and JZ are Medicare billing modifiers for drugs from single-dose containers. JW reports the amount discarded; JZ attests that none was discarded. According to CMS, JW has been required since January 1, 2017 and JZ since July 1, 2023.2
Do Oncology Practices Need a Separate Billing System?
Not necessarily. Some systems combine the clinical record and billing, so charges are prepared from the care that was documented. Northstar, for example, is both an EHR and a revenue platform for oncology practices.
Should an EHR Vendor Sign a Business Associate Agreement?
Under HIPAA, a vendor that creates, receives, maintains or transmits protected health information on a practice's behalf is generally a business associate. HHS guidance describes the business associate agreement required.4 Ask every EHR vendor about it during evaluation.
See How Northstar Answers the Checklist
We'll walk through every item above in the software, with your practice's workflow in mind. Call (307) 301-4304 or email innovate@thecatalyst3.com.
Request a Northstar WalkthroughSources
- KLAS Research, as reported by TechTarget (June 12, 2023). Medical oncology EHR market report. Based on interviews with 158 organizations.
- Centers for Medicare & Medicaid Services. JW Modifier and JZ Modifier Policy: Frequently Asked Questions.
- Centers for Medicare & Medicaid Services. Physician Fee Schedule.
- U.S. Department of Health and Human Services. Business Associates: Frequently Asked Questions.
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