Prostate-specific antigen trackers have been used to monitor patients for postprostatectomy treatment failures on a small scale in Ireland. 8 For a PSA tracker to be successful, the system must have access to all posttreatment PSA data. The VHA is uniquely positioned to leverage this information because most patients who receive treatment for prostate cancer at a VHA facility stay within the VHA system for follow-up care. All laboratory data are also collected and stored in the EMR system, which is sent daily to the VA Corporate Data Warehouse (CDW).
Project Proposal
In November 2014, the Office of Rural Health and the National Radiation Oncology Program Office issued a request for proposal for projects that would improve follow-up care for rural patients with prostate cancer following treatment with radiotherapy. A team of health care providers at the Hunter Holmes McGuire VAMC drafted a proposal to address this problem. Veterans Engineering Resource Centers (VERCs) in Pittsburgh and New England were also included in the proposal as key collaborators. Staff from these 2 centers brought expertise in analytics, implementation, and project management to help rapidly innovate and implement a PSA tracking system.
The proposal was submitted on time and required approval at multiple levels, including facility and VISN leadership. It was essential that the perceived value of the proposal be readily apparent to all stakeholders, or the necessary approvals would not have been obtainable.
The proposal was accepted, and funds were transferred in February 2015. Four core team members led rapid cycle design and prototyping of the PSA tracking system. The project lead and sponsor was a radiation oncologist and service line chief at the Hunter Holmes Mc-Guire VAMC who provided overall strategy, direction, and clinical domain knowledge. A VERC engineer provided project management and analytic expertise, and a VERC developer designed code to pull data from the VA CDW and led design of the user interface. Finally, a nurse practitioner dedicated numerous hours to review charts, contact patients, write notes, and provide user feedback on the system.
Development
The purpose of the radiation oncology-centered PSA tracking system within the VA was to identify patients who require intervention following definitive treatment with radiotherapy before they present with clinical problems from disease recurrence. The PSA tracker that the authors developed was based on a relatively simple algorithm that sorts through thousands of patient records and identifies patients who had a diagnosis of prostate cancer but did not have metastatic disease, were treated at the Hunter Homes McGuire VAMC with radiation therapy, were not seen in clinic within the past 400 days, and did not have a PSA drawn within 450 days or had a rising PSA of 0.5 or more above the lowest PSA value posttreatment. In other words, the tracker uses the power of the CDW to successfully identify the exact charts that need to be reviewed and helped ensure that patients were not lost to follow-up or did not receive appropriate care. Without the PSA tracking system, providers would not know whether or not patients were being missed.