User login
Automation of Cancer Surveillance Care: Using Technology to Improve Outcomes of Care
Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.
Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.
Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.
Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.
Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.
Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.
Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.
Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.
Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.
Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.
Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.
Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.
Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.
Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.
Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.
Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.
Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.
Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.
Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.
Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.
Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.
Lean Six Sigma Applied to Tracking Head/Neck Cancer Patients
Purpose: The ENT Clinic will provide safe and quality care to its head/neck cancer (HNC) patients with optimal treatment interventions and cancer surveillance through regularly scheduled follow-up visits by preventing patients from being inadvertently lost to follow-up care.
Background/Problem: ~ 400,000 new cases of HNC are diagnosed and reported each year. A study reported a 47.3% disease recurrence in the first year post-treatment. HNC patients require frequent follow-up care due to the high percentage of potential disease recurrence.
Before activation of a HNC Cancer Surveillance Program a record review in 2012 showed 31.1% of HNC patients in the ENT clinic were lost to follow-up care when appointments were canceled or missed by patients and did not get a rescheduled appointment.
Methods: Vigorous Lean Six Sigma methodological tools were used to carefully assess the problem and to improve outcomes encompassing such tools as root-cause analysis, defining waste barriers, Plan, Do, Study, Act (PDSA).
In Phase I, an Excel spreadsheet was created to manually track and monitor HNC patients for cancer surveillance. Monthly reports thereafter proved that tracking HNC patients using an Excel spreadsheet was successful, and 100% of HNC patients had received follow-up appointments. However, the manual process of tracking HNC patients on an Excel spreadsheet was time consuming with limited functionality.
Phase II – A robust automated electronic identification system was implemented for tracking HNC patients which included additional features that far exceeded the capabilities of manual tracking.
Data Analysis: During the first 8 months of its operation (February 2014 – September 2014) 25 newly diagnosed HNC patients were identified electronically; patients that manual tracking might have missed.
Results: FY15 and FY16 targeted goal was achieved. 100% of HNC patient appointments were recaptured for cancer surveillance that otherwise might have been lost to follow-up using the automated electronic tracking system.
Implications: The automated HNC Dashboard has proved to be a vital tool providing improved access to care. It can be used and customized for tracking other cancer types.
Purpose: The ENT Clinic will provide safe and quality care to its head/neck cancer (HNC) patients with optimal treatment interventions and cancer surveillance through regularly scheduled follow-up visits by preventing patients from being inadvertently lost to follow-up care.
Background/Problem: ~ 400,000 new cases of HNC are diagnosed and reported each year. A study reported a 47.3% disease recurrence in the first year post-treatment. HNC patients require frequent follow-up care due to the high percentage of potential disease recurrence.
Before activation of a HNC Cancer Surveillance Program a record review in 2012 showed 31.1% of HNC patients in the ENT clinic were lost to follow-up care when appointments were canceled or missed by patients and did not get a rescheduled appointment.
Methods: Vigorous Lean Six Sigma methodological tools were used to carefully assess the problem and to improve outcomes encompassing such tools as root-cause analysis, defining waste barriers, Plan, Do, Study, Act (PDSA).
In Phase I, an Excel spreadsheet was created to manually track and monitor HNC patients for cancer surveillance. Monthly reports thereafter proved that tracking HNC patients using an Excel spreadsheet was successful, and 100% of HNC patients had received follow-up appointments. However, the manual process of tracking HNC patients on an Excel spreadsheet was time consuming with limited functionality.
Phase II – A robust automated electronic identification system was implemented for tracking HNC patients which included additional features that far exceeded the capabilities of manual tracking.
Data Analysis: During the first 8 months of its operation (February 2014 – September 2014) 25 newly diagnosed HNC patients were identified electronically; patients that manual tracking might have missed.
Results: FY15 and FY16 targeted goal was achieved. 100% of HNC patient appointments were recaptured for cancer surveillance that otherwise might have been lost to follow-up using the automated electronic tracking system.
Implications: The automated HNC Dashboard has proved to be a vital tool providing improved access to care. It can be used and customized for tracking other cancer types.
Purpose: The ENT Clinic will provide safe and quality care to its head/neck cancer (HNC) patients with optimal treatment interventions and cancer surveillance through regularly scheduled follow-up visits by preventing patients from being inadvertently lost to follow-up care.
Background/Problem: ~ 400,000 new cases of HNC are diagnosed and reported each year. A study reported a 47.3% disease recurrence in the first year post-treatment. HNC patients require frequent follow-up care due to the high percentage of potential disease recurrence.
Before activation of a HNC Cancer Surveillance Program a record review in 2012 showed 31.1% of HNC patients in the ENT clinic were lost to follow-up care when appointments were canceled or missed by patients and did not get a rescheduled appointment.
Methods: Vigorous Lean Six Sigma methodological tools were used to carefully assess the problem and to improve outcomes encompassing such tools as root-cause analysis, defining waste barriers, Plan, Do, Study, Act (PDSA).
In Phase I, an Excel spreadsheet was created to manually track and monitor HNC patients for cancer surveillance. Monthly reports thereafter proved that tracking HNC patients using an Excel spreadsheet was successful, and 100% of HNC patients had received follow-up appointments. However, the manual process of tracking HNC patients on an Excel spreadsheet was time consuming with limited functionality.
Phase II – A robust automated electronic identification system was implemented for tracking HNC patients which included additional features that far exceeded the capabilities of manual tracking.
Data Analysis: During the first 8 months of its operation (February 2014 – September 2014) 25 newly diagnosed HNC patients were identified electronically; patients that manual tracking might have missed.
Results: FY15 and FY16 targeted goal was achieved. 100% of HNC patient appointments were recaptured for cancer surveillance that otherwise might have been lost to follow-up using the automated electronic tracking system.
Implications: The automated HNC Dashboard has proved to be a vital tool providing improved access to care. It can be used and customized for tracking other cancer types.
Systems Automation for Cancer Surveillance: A Useful Tool for Tracking the Care of Head and Neck Cancer Patients in the Ear, Nose, and Throat Clinic
Purpose: About 400,000 new cases of Head and Neck Cancer (HNC) are diagnosed and reported each year. HNC patients require frequent follow-up care and additional interventions due to the potential for disease recurrence and second primaries. A robust and automated HNC identification and surveillance program can aid in case identification and can track appointments and required care, using the guidelines of the National Comprehensive Cancer Network (NCCN). An automated tool would provide for optimal treatment interventions while preventing any patients from being inadvertently lost to follow-up, enhancing veteran centered care.
Methods: The ear, nose, and throat (ENT) Cancer Tracking System (CTS) queries the VA Corporate Data Warehouse each night to identify all patients recently diagnosed with a HNC. All patients residing in the Albuquerque, New Mexico, and Big Spring, Texas, catchment areas are included in the capture pool. Cases are identified by examining outpatient visits and inpatient discharge diagnosis International Classification of Diseases (ICD) codes, surgical pathology Systematized Nomenclature of Medicine—Clinical Terms (SNOMED codes), and VistA problem list diagnoses. Patients identified as having cancer are presented, using an interactive report hosted on a secure SharePoint site. Newly identified patients are automatically assigned to “active” management status, minimizing the risk of missing a new patient. The coordinator can toggle a patient’s status between “inactive” and “active” at any time, but can never delete a patient from the CTS. Inactive patients with a new cancer diagnosis are automatically toggled to active status. The CTS report tracks and presents a number of pertinent medical indicators, including patient identifiers and residence location, most recent diagnosis date, days since last diagnosis, diagnosis ICD code, date captured on the CTS, most recent ear, nose, and throat (ENT) visit, most recent ENT appointment, days since last visit, date of last thyroid-stimulating hormone (TSH) test, and date of last PET scan. Cancellations, no-shows, and patients overdue for TSH testing are highlighted.
Results: Baseline data obtained in 2012 prior to the activation of the CTS revealed that about 31.1% of diagnosed HNC patients in the ENT clinic experienced delays in care or were lost to follow-up care through cancellations, no shows, and nonrescheduled appointments. A dedicated cancer care coordinator (CCC) was assigned to the ENT clinic to record, monitor, and track HNC patients manually using an Excel spreadsheet. Although cancer surveillance reports proved that launching a cancer surveillance program prevented patients with cancer from being lost to follow-up care, the manual tracking system was time consuming and labor intensive. The automated CTS has optimized cancer surveillance by providing the CCC with immediate identification of new HNC diagnoses, appointment tracking, alerts for HNC patients that have not been scheduled, alerts of overdue required lab tests, tracking of completed PET CT imaging, and improved timeliness in obtaining quality improvement data; all were accomplished without the CCC manually tracking anything.
Conclusions: During the first 4 months of operation (February to May 2014), 14 new HNC patients were identified automatically—patients that manual tracking might have missed or incurred delays in care. The CTS has proved to be a vital tool to the CCC and will continue to assist in the identification of new HNC patients, provide access to patient information on follow-up care, and improve access to recommended diagnostic procedures from NCCN guidelines. Other benefits of an electronic tracking system are optimized time, improved workflows, and improvements to patient safety by providing timely access to care and treatment.
Purpose: About 400,000 new cases of Head and Neck Cancer (HNC) are diagnosed and reported each year. HNC patients require frequent follow-up care and additional interventions due to the potential for disease recurrence and second primaries. A robust and automated HNC identification and surveillance program can aid in case identification and can track appointments and required care, using the guidelines of the National Comprehensive Cancer Network (NCCN). An automated tool would provide for optimal treatment interventions while preventing any patients from being inadvertently lost to follow-up, enhancing veteran centered care.
Methods: The ear, nose, and throat (ENT) Cancer Tracking System (CTS) queries the VA Corporate Data Warehouse each night to identify all patients recently diagnosed with a HNC. All patients residing in the Albuquerque, New Mexico, and Big Spring, Texas, catchment areas are included in the capture pool. Cases are identified by examining outpatient visits and inpatient discharge diagnosis International Classification of Diseases (ICD) codes, surgical pathology Systematized Nomenclature of Medicine—Clinical Terms (SNOMED codes), and VistA problem list diagnoses. Patients identified as having cancer are presented, using an interactive report hosted on a secure SharePoint site. Newly identified patients are automatically assigned to “active” management status, minimizing the risk of missing a new patient. The coordinator can toggle a patient’s status between “inactive” and “active” at any time, but can never delete a patient from the CTS. Inactive patients with a new cancer diagnosis are automatically toggled to active status. The CTS report tracks and presents a number of pertinent medical indicators, including patient identifiers and residence location, most recent diagnosis date, days since last diagnosis, diagnosis ICD code, date captured on the CTS, most recent ear, nose, and throat (ENT) visit, most recent ENT appointment, days since last visit, date of last thyroid-stimulating hormone (TSH) test, and date of last PET scan. Cancellations, no-shows, and patients overdue for TSH testing are highlighted.
Results: Baseline data obtained in 2012 prior to the activation of the CTS revealed that about 31.1% of diagnosed HNC patients in the ENT clinic experienced delays in care or were lost to follow-up care through cancellations, no shows, and nonrescheduled appointments. A dedicated cancer care coordinator (CCC) was assigned to the ENT clinic to record, monitor, and track HNC patients manually using an Excel spreadsheet. Although cancer surveillance reports proved that launching a cancer surveillance program prevented patients with cancer from being lost to follow-up care, the manual tracking system was time consuming and labor intensive. The automated CTS has optimized cancer surveillance by providing the CCC with immediate identification of new HNC diagnoses, appointment tracking, alerts for HNC patients that have not been scheduled, alerts of overdue required lab tests, tracking of completed PET CT imaging, and improved timeliness in obtaining quality improvement data; all were accomplished without the CCC manually tracking anything.
Conclusions: During the first 4 months of operation (February to May 2014), 14 new HNC patients were identified automatically—patients that manual tracking might have missed or incurred delays in care. The CTS has proved to be a vital tool to the CCC and will continue to assist in the identification of new HNC patients, provide access to patient information on follow-up care, and improve access to recommended diagnostic procedures from NCCN guidelines. Other benefits of an electronic tracking system are optimized time, improved workflows, and improvements to patient safety by providing timely access to care and treatment.
Purpose: About 400,000 new cases of Head and Neck Cancer (HNC) are diagnosed and reported each year. HNC patients require frequent follow-up care and additional interventions due to the potential for disease recurrence and second primaries. A robust and automated HNC identification and surveillance program can aid in case identification and can track appointments and required care, using the guidelines of the National Comprehensive Cancer Network (NCCN). An automated tool would provide for optimal treatment interventions while preventing any patients from being inadvertently lost to follow-up, enhancing veteran centered care.
Methods: The ear, nose, and throat (ENT) Cancer Tracking System (CTS) queries the VA Corporate Data Warehouse each night to identify all patients recently diagnosed with a HNC. All patients residing in the Albuquerque, New Mexico, and Big Spring, Texas, catchment areas are included in the capture pool. Cases are identified by examining outpatient visits and inpatient discharge diagnosis International Classification of Diseases (ICD) codes, surgical pathology Systematized Nomenclature of Medicine—Clinical Terms (SNOMED codes), and VistA problem list diagnoses. Patients identified as having cancer are presented, using an interactive report hosted on a secure SharePoint site. Newly identified patients are automatically assigned to “active” management status, minimizing the risk of missing a new patient. The coordinator can toggle a patient’s status between “inactive” and “active” at any time, but can never delete a patient from the CTS. Inactive patients with a new cancer diagnosis are automatically toggled to active status. The CTS report tracks and presents a number of pertinent medical indicators, including patient identifiers and residence location, most recent diagnosis date, days since last diagnosis, diagnosis ICD code, date captured on the CTS, most recent ear, nose, and throat (ENT) visit, most recent ENT appointment, days since last visit, date of last thyroid-stimulating hormone (TSH) test, and date of last PET scan. Cancellations, no-shows, and patients overdue for TSH testing are highlighted.
Results: Baseline data obtained in 2012 prior to the activation of the CTS revealed that about 31.1% of diagnosed HNC patients in the ENT clinic experienced delays in care or were lost to follow-up care through cancellations, no shows, and nonrescheduled appointments. A dedicated cancer care coordinator (CCC) was assigned to the ENT clinic to record, monitor, and track HNC patients manually using an Excel spreadsheet. Although cancer surveillance reports proved that launching a cancer surveillance program prevented patients with cancer from being lost to follow-up care, the manual tracking system was time consuming and labor intensive. The automated CTS has optimized cancer surveillance by providing the CCC with immediate identification of new HNC diagnoses, appointment tracking, alerts for HNC patients that have not been scheduled, alerts of overdue required lab tests, tracking of completed PET CT imaging, and improved timeliness in obtaining quality improvement data; all were accomplished without the CCC manually tracking anything.
Conclusions: During the first 4 months of operation (February to May 2014), 14 new HNC patients were identified automatically—patients that manual tracking might have missed or incurred delays in care. The CTS has proved to be a vital tool to the CCC and will continue to assist in the identification of new HNC patients, provide access to patient information on follow-up care, and improve access to recommended diagnostic procedures from NCCN guidelines. Other benefits of an electronic tracking system are optimized time, improved workflows, and improvements to patient safety by providing timely access to care and treatment.