Introduction: The National Oncology Program office seeks to provide tools that can electronically capture data elements that can help VA facilities and programs assess the quality of cancer care being provided to veterans. Manual extraction of standards-of-care data from CPRS is resource intensive and difficult to sustain. This is particularly true for data elements embedded in large text fields such as progress notes.
Methods: Nine reminder dialogs were developed: treatment plan, treatment summary, multidisciplinary conference note (breast, prostate, colorectal), breast cancer, colorectal cancer,
symptom management tool, and an interval note. Each reminder dialogs include data elements that can be used to assess quality indicators (e.g., date of diagnosis, stage, performance status, chemotherapy agents used, radiation therapy sites, start/stop dates, surgery types, and outcomes) that align with the Commission on Cancer guidelines and the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) standards.
To extract the data electronically, distinct health factors are embedded with each of the data elements. Sequential Query Language (SQL) software is used to extract these health factors from the Corporate Data Warehouse. SQL code can be run as a script to update data iteratively (e.g., every 24 hours), thus eliminating manual data extractions.
Results: The reminder dialogs have undergone or will undergo formal usability testing (UT) prior to national release in fall 2016. The UT participants were selected because they are potential end users, and their input is vital to ensuring the dialogs follows current workflow.
Key improvements were made based upon the UT feedback. The breast cancer reminder dialog had additional surgery types added and a section to document why chemotherapy and radiation standards of care were not followed (patient refusal and contraindicated). Every date field in all 9 reminder dialogs was changed to facilitate ease of data entry.
Conclusion: Reminder dialogs provide a standardized documentation tool for QOPI oncology programs. SQL software provides a mechanism for streamlining QOPI data reporting. Both provide a way for VA to monitor cancer quality care in VA.