Presentation on theme: "Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarization."— Presentation transcript:
1 Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarizationJeremy L. Warner, Suzanne E. Maddux, Kevin S. Hughes, John C. Krauss, Peter Paul Yu, Lawrence N. Shulman, Deborah K. Mayer, Mike Hogarth, Mark Shafarman, Allison Stover Fiscalini, Laura Esserman, Liora Alschuler, George Augustine Koromia, Zabrina Gonzaga, Edward P. Ambinder
2 Consider this Realistic Situation A postmenopausal, diabetic woman has been diagnosed with early-stage invasive breast cancerShe will require surgery, adjuvant (postoperative) chemotherapy, radiation treatment, and hormonal therapyShe has an established relationship with a local primary care physician (PCP) and an endocrinologistShe lives 150 km from a National Accreditation Program for Breast Centers (NAPBC) Center of ExcellenceThe nearest infusion center for chemo is 50 km awayNone of her providers share an interoperable electronic health record (EHR)
3 A Tangled Web Patient Caregivers PCP Visiting Nurse Nursing Home Surg OncMed OncPCPNursing HomeRad OncVisiting NurseWithout standards, communication pathways may be haphazard, incomplete, and nonsynchronous.
9 ASCO’s Approach to HL7Working with Lantana Consulting to develop HL7 CDA templates for ASCO’s Breast Cancer Adjuvant TPSDevelop oncology-specific CDA templatesCDA templates are re-usable, incremental, and extensible.C-CDA is referenced in MU Stage 2.Harmonize and re-use existing oncology profilesNCI templatesCDC Implementation Guide for Healthcare Reporting to Central Cancer RegistriesAdapted from 2013 Oncology Standards Summit
12 Deconvoluting Patient PCP Med Onc Visiting Nurse Surg Onc Rad Onc Secondary needsSurg OncMed OncPCPNursing HomeRad OncVisiting NurseStandards enable reliable, complete, and replicable communication—with or without a central source of truth, such as a health information exchange
14 Chemotherapy Treatment Plan and Summary Templates Goal: to enable continuity of care even with the loss of medical records e.g. KatrinaPaper-based documents used during the cancer work-up and treatment planning phase, treatment, and as a summary after completion of treatmentBreast, Colon, Lung (SCLC/NSCLC), LymphomaCurable breast cancer is a common but fairly complex scenario, selected for CDA DSTU1
17 80+ data elementsNumeric (e.g. medical record number; OncotypeDX recurrence score)Dated (e.g. patient date of birth)Encodeable to an HL7-recognized terminology (e.g. Breast TNM node category SNOMED-CT, US Realm)Encoded to an HL7 RIM Class (e.g. Practice site Entity Class)Narrative representation
27 Second Implementation of eCOTPS: Project INSPIRE INSPIRE: INteroperability to Support Practice Improvement, Disease REgistries, and Care CoordinationGOAL: Improve acquisition and exchange of patient data in high impact conditions in order to support longitudinal disease registries, care coordination, and practice improvementAdapted from 2014 Oncology Standards Summit
28 Athena-INSPIRE: Today and the Future EHR 1Our Goal (Future):ASCO/HL7 eCOTPSCAPeCC XMLEHR 2EHRASCO/HL7 eCOTPSState Central Cancer RegistryASCO/HL7 eCOTPSDynamic Form for Data Capture(XML-driven and questionnaire like with skip/branch, etc…. Rendered *within* EHR)ASCO/HL7 eCOTPSHealth Information HomeToday:Prototype Health Information Home (HIH)Cloud Web-appASCO/HL7 eCOTPSHTML window rendering external web appVisual Force Web AppEpicCareEpic Desktop ClientAdapted from 2014 Oncology Standards Summit
29 The eCOTPS Mapping Project Task: Map Athena checklist data elements using eCOTPSChallenges:Athena checklist elements are much more comprehensive than those specified in the eCOTPS and meant to be entered in real-time to facilitate care coordinationAthena checklist data are often at a finer level of detail than is specified in the eCOTPS specificationUse cases for the Health Information Home (HIH) also specify a finer level of detailRequires adding appropriate templates to the eCOTPS, and deciding on their location in the eCOTPS structuresAdapted from 2014 Oncology Standards Summit
30 The Mapping Project: Issues I Discovering the proper codes to represent the Athena concepts: using SNOMED, LOINC, PhinVads, and other terminology browsersRequires working with terminology standards organizations to create new codes, and/or using codes from several organizations not mentioned in the eCOTPS specificationOften requires creating combinations of codes (and structures) to create a better mapping (using the CTS2 strategies for mapping codes to HL7 V3 structures)Creating, adapting and using the CDA templates required by the Athena use of the eCOTPS specification.Adapted from 2014 Oncology Standards Summit
31 The Mapping Project: Issues II The eCOTPS needs to be sent multiple times to the HIH as a patient proceeds through their “cancer journey.”This means that additional administrative details (id’s, signatures, etc.) must be added to the eCOTPS.The current stage of the project deals primarily with the machine-readable, structured aspects of the eCOTPS. Human-readable representation details left for a second stage.Adapted from 2014 Oncology Standards Summit
32 SummaryeCOTPS is the first oncology-specific CDA standard to achieve HL7 DSTU statusLessons learned during design and implementation have led to improvements in the draft standardeCOTPS is now in DSTU R2, with addition of Colon Cancer Adjuvant Treatment Plan & Summary template definitionsFuture roadmap includes adding other disease sites, survivorship, patient-reported outcomes, and balloting for normative status
Your consent to our cookies if you continue to use this website.