BREAST CANCER ONCOLOGY NAVIGATION SERVICE Identification/ referral Coordination Diagnostic phase Staging/ treatment phase Longitudinal Follow-up Coordination with primary care Mammogram referral BI-RADS 4 or 5 (needs biopsy) Patient gets imaging Receptor status, molecular subtypes Hand-off to “navigator” eReferral to referring (sporadic) Patient gets mammogram PCP referral to case management Post-diagnosis evaluation Navigator documents on “navigator notes” Email or phone call communication Patient gets biopsy Radiology interpretation; f/u recommendation Case details and intake written into a binder Call patient to apprise and/or arrange visit Imaging, additional labs, bone scans Schedules f/u studies and/ or procedures Mammogram service apprises referring provider Order additional diagnostics studies as necessary Present case at breast tumor board (every 2 weeks) Surgery, oncology, radiation oncology, treatments eReferral to referring provider Outcome entered into binder Post surgical assessments Particular “pain point” Patient contact and ensure that appointments are kept (phone calls, emails, letters)

PULMONARY NODULE JOURNEY MAP Identification/ referral Coordination (Pulmonary nurse) Coordination (Pulmonary service) Diagnosis and staging Longitudinal f-u Coordination with primary care Places on Word document F/u imaging schedule Place schedule on Word document Receive f/u plan from pulmonary Abnormal imaging Biopsy with chest radiology eReferral to pulmonary service Alert pulmonary service Schedule f/u imaging Follow f/u imaging plan Staging: PET CT (external referral) bronchoscopy/ surgery eReferral attending reviews consultation Check insurance status (refer to eligibility) Consultation with chest radiology Schedule f/u studies and/ or procedures Risk assessment: pulmonary function test, cardiology studies, exercise testing Pulmonary outpatient diagnostic service referral Make recommendations: imaging f/u vs. procedure Establishes PCP if none Notify patient of plan Notify referring provider Patient to surgery, medical oncology, radiation oncology Particular “pain point” Patient contact and ensure that appointments are kept (phone calls, emails, letters)

PROSTATE CANCER JOURNEY MAP Identification/ referral Coordination (Urology team) Consultation (Urology Attending) Care Pathway (“Active surveillance”) Care Pathway Longitudinal f-u/ coordination with PCP Elevated PSA > 4 ng/ml Patient comes in for urology f/u Adjudicate need for biopsy Add patient to “registry” (list) Intermediate-high risk/ metastatic Resident on 4- month block DRE and informed decision-making regarding need for biopsy Resident fills in tracking “book” (binder) Assign risk categories and assign f/u pathway PSA f/u with option for biopsy (every 1-2 years) Patient assigned to treatment pathway Requisitions, lab orders, lab “book”, EHR documents Patient scheduled for biopsy Referral to Radiation Oncology Communicate plan to PCP Back to PCP if "watchful waiting" Assigned "Active surveillance" pathway Referral to Medical Oncology Surgical intervention Patient contact and ensure that appointments are kept (phone calls, emails, letters) Particular “pain point”