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Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarization.

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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 summarization Jeremy 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 1

2 Consider this Realistic Situation  A postmenopausal, diabetic woman has been diagnosed with early-stage invasive breast cancer  She will require surgery, adjuvant (postoperative) chemotherapy, radiation treatment, and hormonal therapy  She has an established relationship with a local primary care physician (PCP) and an endocrinologist  She lives 150 km from a National Accreditation Program for Breast Centers (NAPBC) Center of Excellence  The nearest infusion center for chemo is 50 km away  None of her providers share an interoperable electronic health record (EHR) 2

3 A Tangled Web  Without standards, communication pathways may be haphazard, incomplete, and nonsynchronous. Patient Caregivers Surg Onc Med Onc PCP Nursing Home Rad Onc Visiting Nurse 3

4 2013 Oncology Standards Summit 4

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7 Initial Project Vision 2013 Oncology Standards Summit 7

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9 ASCO’s Approach to HL7 Harmonize and re-use existing oncology profiles –NCI templates –CDC Implementation Guide for Healthcare Reporting to Central Cancer Registries CDA templates are re-usable, incremental, and extensible. C-CDA is referenced in MU Stage 2. Working with Lantana Consulting to develop HL7 CDA templates for ASCO’s Breast Cancer Adjuvant TPS Develop oncology-specific CDA templates Adapted from 2013 Oncology Standards Summit

10 Templated CDA Many different kinds of documents A selection of reusable templates © CDA Academy, 2012 MedicationsPayer Social History Demographics Allergies.. Vital Signs Chief ComplaintDischargeDiagnosis Problems CDA document using CCD templates CDA document using CCD templates plus others Mode ofTransportNew Section… Family History Surgical Finding Discharge Diet CDA CCD

11 Consolidated CDA R1 (Cited in MU2) © CDA Academy, 2012 CDA templates for common document types:  Continuity of Care Document (CCD) plus  Consultation Note  Diagnostic Imaging Report  Discharge Summary  H & P  Operative Note  Procedure Note  Progress Note  Unstructured Document Benefits  More comprehensive patient information than the CCD  Continuity of care is improved

12 Deconvoluting  Standards enable reliable, complete, and replicable communication—with or without a central source of truth, such as a health information exchange Patient Secondary needs Surg Onc Med Onc PCP Nursing Home Rad Onc Visiting Nurse 12

13 Hurricane Katrina, ”…tens of thousands of records have been lost.” - Economist Public domain © Associated Press

14 Chemotherapy Treatment Plan and Summary Templates  Goal: to enable continuity of care even with the loss of medical records e.g. Katrina  Paper-based documents used during the cancer work-up and treatment planning phase, treatment, and as a summary after completion of treatment  Breast, Colon, Lung (SCLC/NSCLC), Lymphoma  Curable breast cancer is a common but fairly complex scenario, selected for CDA DSTU1 14

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17 17  80+ data elements  Numeric (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

18 18 Warner et al. JAMIA 2015

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20 eCOTPS New Template Example 20

21 2014 Oncology Standards Summit First Implementation of eCOTPS: Health Story Project 21

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23 2014 Oncology Standards Summit 23

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27 Second Implementation of eCOTPS: Project INSPIRE INSPIRE: INteroperability to Support Practice Improvement, Disease REgistries, and Care Coordination GOAL: Improve acquisition and exchange of patient data in high impact conditions in order to support longitudinal disease registries, care coordination, and practice improvement 27 Adapted from 2014 Oncology Standards Summit

28 Athena-INSPIRE: Today and the Future EHR CAP eCC XML Dynamic Form for Data Capture (XML-driven and questionnaire like with skip/branch, etc…. Rendered *within* EHR) Cloud Web-app Prototype Health Information Home (HIH) Visual Force Web App Epic Desktop Client HTML window rendering external web app EHR 1 EHR 2 State Central Cancer Registry Health Information Home ASCO/HL7 eCOTPS EpicCare Adapted from 2014 Oncology Standards Summit

29 The eCOTPS Mapping Project Task: Map Athena checklist data elements using eCOTPS Challenges: – Athena checklist elements are much more comprehensive than those specified in the eCOTPS and meant to be entered in real-time to facilitate care coordination – Athena checklist data are often at a finer level of detail than is specified in the eCOTPS specification – Use cases for the Health Information Home (HIH) also specify a finer level of detail – Requires adding appropriate templates to the eCOTPS, and deciding on their location in the eCOTPS structures Adapted 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 browsers – Requires working with terminology standards organizations to create new codes, and/or using codes from several organizations not mentioned in the eCOTPS specification – Often 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 Summary  eCOTPS is the first oncology-specific CDA standard to achieve HL7 DSTU status  Lessons learned during design and implementation have led to improvements in the draft standard  eCOTPS is now in DSTU R2, with addition of Colon Cancer Adjuvant Treatment Plan & Summary template definitions  Future roadmap includes adding other disease sites, survivorship, patient-reported outcomes, and balloting for normative status 32


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