Cancer pathways - Communication and documentation
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Cancer pathways: Communication and documentation. Presented by Janfrey Doak, Southern Cancer Network and Phyllis Meier, Central Cancer Network, at HINZ 2014, 12 November 2014, 11.15am, Plenary Room 2
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Cancer pathways - Communication and documentation
- 1. Cancer Pathways Communication and Documentation Phyllis Meier, Project Manager, Central Cancer Network Janfrey Doak, Project Manager, Southern Cancer Network
- 2. Origins of the Solution 2010 HINZ Clinicians’ Challenge MidCentral DHB Colorectal Cancer Care Nursing Service Develop solution ensure a seamless timely interface between hospital and community based care and social support systems = Orion Health Clinical Workflow Suite Cancer Pathway and MDM Management Solution Colorectal Cancer Awareness and Diagnosis Treatment Surveillance Survivorship Referral to First Treatment Colorectal Lung Gynae Other Tumour Streams
- 3. Current challenges in cancer care Complex patient journey Involves multiple services/hospitals Documentation and communication methods inconsistent across services and DHBs Records are often hidden and isolated Visibility compromised or non existent across DHBs Data collection problematic, inconsistent, retrospective, and largely unstructured for reporting
- 4. Proof of Concept (PoC) Pathway - SCN/CCN, Orion Health - Referral to First Treatment, - Demo environment, Clinical Workflow Suite - DHB Clinical Portal 62 day Indicator Requirements • Robust and Sustainable • Documentation/communications fully integrated with patients EMR • Visible across DHBs, Regions, and into primary care • Data input routine patient care • Structured and usable (enter/re-use) MDM Process
- 5. PoC Demonstrations Mock lung cancer pathway Orion Health hosted demo environment 150 + attendees Overall strong support for development and implementation (local/regional/potentially national solution) Need for MDM Management solution was URGENT in majority of DHBs Current focus on progressing MDM Patient Management tool within pathway…
- 6. Multidisciplinary Meeting Integral step in pathway to treatment for many patients Cancer specialists with expertise in a range of different specialties review imaging, pathology, laboratory etc Discuss/identify optimal treatment options or care Meetings require real time accurate documentation of discussion Efficient timely documentation, communication follow-up of treatment recommendations Structured data as bi-product of clinical documentation Robust and reliable tool is VITAL!
- 7. MDM Pathway Requirements • Web based electronic registration/referral tool for direct entry of patients to each tumour stream MDM (enabled via VPN or Citrix etc…) • Linkage to local PAS/PMS for validated NHI demographics • 3rd party integration (Mosaiq, Aria) • Automatic population of the MDM request form / proforma from registration/referral data and or other 3rd party applications and patient management systems.
- 8. MDM Agenda Requirements • Automatic agenda entry from registration / referral data • Agenda items are easily sequenced and printable • Distributed to participants if required • Agenda is accessible by clinicians as required • Generic search for MDM agenda • Electronic MDM calendar management • ability to automatically restrict registration / referral to an MDM past the agreed cut off times • ability to be modified as required by MDM coordinator • Alerts referrer / MDM coord / MDM chair when addition to agenda is past the cut off time • Provides a popup alert instructing referrer on how to contact Path/Rad as required • Access/security management to ensure access is appropriate to user type (admin, MDM coord, attendees) • Ensures hyperlinks and data points are auto populated to forms
- 9. Radiology / Pathology Tasks Requirements • Electronic advisory to Pathologist and Radiologist when a patient is to be reviewed for MDM
- 10. Radiology / Pathology Task Requirements • Ensure hyperlinks and data points are auto populated to forms
- 11. MDM Discussion and Proforma Completion Requirements • Electronic proforma per tumour stream MDM for real-time documentation of MDM discussion and recommendations • Electronic recording of individual clinician attendance (per individual patient discussion and per MDM), with appropriate reporting capability • Proformas are customisable to meet Local / Regional / National initiatives (based on National agreement for each tumour stream) • Linkage to MDM / cancer data collection systems where these exist (Metriq) • Adjustments for change requests within MDM forms / documents (nationally agreed) • Adjusts easily to emerging requirements
- 12. Auto populated data from referral (un-editable and editable) Requirements • Automatic population of the MDM proforma from registration / referral data provided by referring clinician (to include PAS, Rad/Path tasks, 3rd party) • Automatic population of the MDM proforma from registration / referral data provided by referring clinician (to include PAS, Rad/Path tasks, 3rd party)
- 13. Record of discussion Requirements • Automatic population of the MDM proforma from registration / referral data provided by referring clinician (to include PAS, Rad/Path tasks, 3rd party)
- 14. Diagnosis and staging Requirements • Electronic proforma per tumour stream MDM for real-time documentation of MDM discussion and recommendation • Proformas are customisable to meet local / regional / national initiatives (based on National agreement for each tumour stream)
- 15. Recommendations: Investigations Treatment recommendations Requirements • Electronic proforma per tumour stream MDM for real-time documentation of MDM discussion and recommendation • Proformas are customisable to meet local / regional / national initiatives (based on National agreement for each tumour stream)
- 16. Referrals Requirements • Ensure hyperlinks and data points are auto populated to forms
- 17. Rescheduling Patients Subsequent MDM Requirements • Finalised proforma finished as part of the Electronic Medical Record System (ERMS) for each patient discussed
- 18. Summary of MDM Requirements • Automatic production of MDM summary of recommendations (by patient and per meeting) • NHI • Patient Name • Clinical presentation / history • Recommendation • Distribution of MDM summary or recommendations electronically to General Practitioner (GP) • Distribution of MDM summary or recommendations electronically to MDM attendees
- 19. History and Version Control Requirements • Clinical document tree • Patient notes – ongoing version control and audit trail
- 20. Version 1 Document View Requirements • Patient notes – ongoing version control and audit trail
- 21. PDF for Primary Care Requirements • Proforma is easy to print and email (PDF)
- 22. Collectable Structured Data Requirements • Structured data reporting (data elements designed to meet reporting business rules and data definitions) • View export / reporting of data via UI • Field names and formatting follow reporting business rules and data definitions
- 23. Next Steps Engagement with key stakeholders secured Strong support expressed for advancement to development phase Presentations planned to IT sector, NICLG and opportunity NHITB and others Anticipate alignment Cancer Information Strategy Identify funding source…
- 24. Acknowledgements… Orion Health Matt Hemens, Mark Rainford, Rowan Walker, Susan Philp PoC Steering Group and Sponsors South Island and Central Cancer Network DHB’s Clinicians and CNCs South Island IS Service Level Alliance Paul Goddard Southern and Central Cancer Network Managers Di Riley and Jo Anson
Editor's Notes
- innovative electronic solution to address current communication documentation, and data collection issues within the New Zealand cancer care setting. With a focus on the patient pathway from first referral through to first treatment
- To being we would like to take you back in time to explain where the functionality of the solutions stems from, the HINZ Clinicians Challenge in 2010 “to ensure a seamless and timely interface between hospital and community based continued care and social support systems”, by the MidCentral DHB Colorectal Cancer Care Nursing Service In response to this Orion Health developed Clinical Workflow Suite. We have taken this technology and developed a pathway from first referral with HSCan through to first treatment with encompasses the Multidisciplinary Meeting Management processes.
- One of the incentives to undertaking this work was to address current challenges in cancer care. The cancer patients journey can be complex and involve multiple services. We see inconsistent documentation and communications within and between DHBs Documentation and communications can be hidden in health care records and isolated from and in services There are inconsistencies in MDM management and documentation within and between DHBs Compromised or non-existent visibility of patient care Data is largely inconsistent, retrospective, and unstructured for collection and reporting.
- A Proof of Concept (PoC) was undertaken with Orion Health to develop and test Cancer Pathway and Multidisciplinary Meeting (MDM) Management solution with an initial focus on lung cancer pathway based on Clinical Workflow Suite, the original clinician challenge This solution documents and displays, in real time, clinical inputs in a reusable and structured format with a potential to provide visibility of patient care across District Health Board (DHB) boundaries. The solution provides: An IT solution to support cancer care delivery that is robust and sustainable Provides electronic documentation, communication and coordination function, that is fully integrated with the patients' electronic medical record and is visible across DHBs, regions, and into primary care Provide a comprehensive Multidisciplinary Meeting (MDM) Management tool to support regional and supra-regional MDMs. Ensure that data input, through routine patient care, is structured and usable for all types of reporting (local, regional, national) PoC demonstrations of this system were undertaken across New Zealand. Demonstrations were comprehensive and moved the attendee form the start of a patients cancer journey to the first treatment where the pathway was completed. We found though demonstrations that this narrow view is still a very complicated process, and it was agreed that in order to see this project come to production, that we should again narrow our focus to MDM Management and ensure the system is capable of collectable, structured data as by-product of MDM management. Engagement with key stakeholders has been secured, and strong support has been expressed for the advancement of this project into a development phase.
- Clearly there must be robust electronic system to support these important functions and activities.
- What is an MDM? Ministry of Health “MDMs are a deliberate, regular, face-to-face (or videoconference) meeting to facilitate prospective multidisciplinary discussion of options for patients‘ treatment and care by a range of health professionals who are experts in different specialities. Prospective treatment and care panning refers to making recommendations in real time, with an initial focus on the patient's primary treatment. MDMs facilitate a holistic approach to the treatment and care of the patient. Nelson Specialists determines patient for MDM discussion Specialist opens MDM pathway MDM request form generates a task to requesting consultant to complete the proforma Consultant completes proforma This generates tasks to Radiology, Pathology, and populates the agenda Data fields: Are auto populated where applicable Will roll over to proforma Will generates Pathology Radiology tasks as required
- The MDM Coordinator accesses and manages the agenda As the proformas are completed the agenda updates in real time The agenda is sortable and the MDM Coordinator can create favourite searches to quickly sort as required Colour coding makes for easy assessments of due dates at a glance Pathology and radiology requests are visible at a glance MDM Coord is able to link documents for review, as required
- Radiology and Pathology services review tasks lists Tasks are assigned to appropriate Pathologist / Radiologist Tasks are then generated for specific Pathologist / Radiologist as required
- This task your seeing was underdeveloped as a result of PoC constraints. Tasks generated to Pathology and Radiology would include roll over data from the request from giving the Rad/Path a view of patient information and background Patient background Question for MDM Location of slides /films Question for Radiology / Pathology All data entered by Radiology / Pathology, in turn, auto populates the MDM proforma
- At the MDM, the coordinator can populate the proforma in real time. Coordinator records attendance by exception (deletes those not in attendance, or adds one off attendees)
- Roll over data from referral Un-editable Editable
- MDM Coordinator records discussion in real-time This section of the proforma is also under developed and would include the task information that was previously prepared by the Radiologist / Pathologist
- Provides source for national data set collections based on tumour stream standards This section may be auto-populated from the Pathology task that was previously populated
- Real-time documentation of further investigation or treatment recommendations are completed
- There is potential for this solution to provide a seamless integrate with the eReferrals product By ticking off a box indicating the patient needs a referral, data then populates an e-referral form and it is sent in real time
- If a patient requires further investigation they can be rescheduled for a subsequent MDM Patient rescheduled for subsequent MDM Rescheduling is then reflected on agenda in real time and additional tasks can be submitted
- Summary of MDM recommendations is generated in real time and can be accessible by attendees or the GP as required. This summary can also be printed in excel if required
- Each subsequent completion of the proforma will then sit in the CDV tree to view Subsequent discussions and recommendations are protected and viewable through version control
- Older versions are easily accessible and clearly marked
- Finished proforma easily converted to PDF for distribution as required
- MDMs are a data rich environment Data input at an MDM is structured and data collectable Structured data is useable for reporting locally, regionally, or nationally as required