Georgia Cancer Quality Information Exchange

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1 Georgia Cancer Quality Information Exchange Measuring Progress, Motivating Change William J. Todd President & Chief Executive Officer October 5, 2009

2 Hamilton Jordan

3 Georgia Cancer Coalition Mission: Reduce the number of cancer related deaths in Georgia. Goals: 1. Prevent cancer and detect existing cancers earlier. 2. Provide quality care for all Georgians with cancer. 3. Establish ongoing, collaborative processes for addressing cancer data and metrics issues in Georgia. 4. Have Georgia become a destination site for cancer patients, biotechnology, and biomedical companies in the southeastern United States. 5. Generate a combination of state, federal, and private funds to support the fight against cancer.

4 Key Statewide Initiatives 1. NCI Designation Emory Winship Cancer Institute 2. Distinguished Cancer Clinicians and Scientists (DCCS) 3. Georgia Center for Oncology Research and Education (GA CORE) 4. Bio-Repository Alliance of Georgia for Oncology (BRAG Onc) 5. NCI Community Cancer Center Program (NCCCP) 6. Georgia Cancer Quality Information Exchange

least one article ranking in the top 10 of mostcited research in

5 Distinguished Cancer Clinicians and Scientists (DCCS) Cornerstone Program 118 Active Scholars 8 out of 10 Scholars have written at least one article ranking in the top 10 of mostcited research in their fields of study $200 million in federal and private research funding

Multi-Specialty Statewide Research Network 186 Academic and Community Oncologists 57 Research Sites, 26 Cities Aims Expand access to clinical trials Promote research-driven improvements in oncology

6 Multi-Specialty Statewide Research Network 186 Academic and Community Oncologists 57 Research Sites, 26 Cities Aims Expand access to clinical trials Promote research-driven improvements in oncology care Design and conduct clinical trials Use technology to exchange information and improve research efficiency Programs Public database of all clinical trials with investigator profiles Multi-specialty working groups, videos, E tumor boards, webcasts and podcasts Single point-of-entry for multi- Gynecology Oncology Group, pharma and investigatorinitiated trials Web-based Investigators Exchange for protocol review, study management

7 Bio-Repository Alliance of Georgia for Oncology (BRAG Onc) Critical to enabling modern molecular-based research including genomics, proteomics, and molecular imaging. Drive development of a new generation of targeted, personalized diagnostics and therapies. Pathology data availability significantly strengthens research proposals of Georgia s investigators. Resource to both academic and community cancer researchers. Supports recruitment of cancer researchers to the state.

8 NCI Community Cancer Center Program (NCCCP) Pilot Research Initiative to explore development of national network of hospital-based community cancer centers. 85% of cancer patients treated in community hospitals. 14 Hospitals awarded will share best practices. Four year pilot requires awardees to improve on metrics in the 6 pillars.

IOM Report on Measurement Commissioned the Institute of Medicine to develop a strategy for measuring progress in cancer control Report titled Assessing the Quality of Cancer Care in Georgia: An

9 IOM Report on Measurement Commissioned the Institute of Medicine to develop a strategy for measuring progress in cancer control Report titled Assessing the Quality of Cancer Care in Georgia: An Approach to Measurement 52 measures recommended; focused on breast, colorectal, lung, and prostate Measures structured around the continuum of care Prevention; Early Detection & Screening; Diagnosis & Staging; Treatment & Palliation

10 Georgia s Comprehensive Cancer Control Plan Program of the CDC Collaborative process; communities pool resources to reduce cancer burden Participants 125 volunteers from across Georgia Result Revised 5 year CCC Plan Plan structured on the IOM report: 52 measures, across continuum of care Cross-cutting issues include eliminating disparities; increasing access; and, survivorship

11 The Exchange Dashboard IOM Quality of Care Indicators Prevention Detection Diagnosis Treatment Adult Smoking Adolescent Smoking Advice to Quit Smoking Pharmacotherapy to Quit Smoking Adult Obesity Breast Cancer Screening Colorectal Cancer Screening Early-stage Breast Cancer Advanced-stage Breast Cancer Advanced-stage Colorectal Cancer Timely Breast Cancer Biopsy Needle Biopsy For Breast Cancer Clean Margins Breast Surgery Hist Assessment Breast Cancer Hist Assessment Colorectal Cancer Participation in Clinical Trials Inappropriate Hormonal Therapy Appropriate EBRT Prostate Cancer EBRT/Hormone Prostate Cancer Adjuvent Radiation Breast Cons Surg Cancer Deaths In Hospice Hospice Length of Stay Breast Cancer 5/10 Survival Rate Colorectal Cancer 5/10 Survival Rate Lung Cancer 5/10 Survival Rate Cancer Incidence All Sites Path Compliance for Specimens Adjuvent Hormon. Inv Breast Cancer Prostate Cancer 5/10 Survival Rate Breast Cancer Incidence Path Reports for Breast Cancer Adjuvent Chemo Breast Cancer Breast Cancer Mortality Rate Colorectal Cancer Incidence Path Reports for Colorectal Cancer Adjuvent Chemo Colorectal Cancer Colorectal Cancer Mortality Rate Lung Cancer Incidence Path Reports for Lung Cancer Mammography After Treatment Lung Cancer Mortality Rate Prostate Cancer Incidence Path Reports for Prostate Cancer Colonoscopy After Treatment Prostate Cancer Mortality Rate Breast Cancer Stage Determined Cancer Pain Assessment All Cancers Mortality Rate Colorectal Cancer Stage Determined Prevalence of Pain Cancer Patients Lung Cancer Stage Determined Prostate Cancer Stage Determined

12 From Initial Concept to Reality Stage One Stage Two Demonstration Partners Statewide Technology Infrastructure Mainstream Partners Additional Stakeholders Collaboration

13 Accomplishments: Six Demonstration Partners

14 Accomplishments: Numerous Improvements in Patient Care Real Time Cancer Patient Staging Community tumor board uses EMR to stage patients in real time to improve timeliness of staging for all patients prior to treatment to ensure patients are on best treatment protocols for specific cancers. Reduced Time to Biopsy Reduction of time from abnormal mammogram to biopsy Reduced from 21+ to less than 7 days Improved Cancer Patient Pain Management Pain is quickly becoming accepted as the fifth vital sign. Physicians assumed their patients pain was well managed. Trended data reported high levels of pain, processes were quickly redesigned and trends tracked.

15 Technology Proof-of-Concept Technology Infrastructure to accept data from all providers Regardless of level of automation or technology platform Reporting mechanism that is both Exchange-wide Facility-specific Multiple views of data Dashboard Drill-downs Standard Reports Ad-hoc reporting to answer specific questions Forum for information sharing and collaboration

16 Proof-Of-Concept Phased Approach Oct. 1

17 POC Architecture and Data Flow

Dashboard at state level Provides standardized Performance

18 The Exchange Portal Primary means of access Supports data entry for nonautomated Members Results in aggregated Dashboard at state level Provides standardized Performance Reports for member organizations Will drive rapid expansion of membership

19 Accomplishments: Benefits Realized Timely dissemination of current scientific/best practice ( what we know ) knowledge Improved diagnosis Optimal treatment planning Education and advise regarding risky behaviors Screening reminders, alerts & immediate scheduling Outreach to broad populations including those with disparities Debate, interaction and alignment across physician specialties and sites of care Reduction of variability which decreases costs and error through standardization of work flows Expanded accrual to clinical trials through linkage to Ga- CORE Improved patient service Adoption of best practice locally, regionally and across the state

20 Future Potential Key learning laboratory for Meaningful Use Improve quality, safety, efficiency and reduce health disparities Engage patients and families Improve Care Coordination Improve Patient and Population Health Ensure adequate privacy and security protections for personal health information Longitudinal Cancer EMR Complete picture of patient across care entities Real-time Cancer EMR Across organizations To the betterment of patient care Setting the National Standard

21 GCC Key Initiatives Distinguished Cancer Clinicians and Scientists (DCCS) Georgia Center for Oncology Research and Education (GA CORE) Georgia Cancer Quality Information Exchange Bio-Repository Alliance of Georgia for Oncology (BRAG Onc) NCI Community Cancer Center Program (NCCCP) Georgia Comprehensive Cancer Control Plan

22 Georgia Cancer Quality Information Exchange Measuring Progress, Motivating Change William J. Todd President & Chief Executive Officer October 5, 2009

REPORT. A Model Clinical Trials System for the 21st Century

REPORT. A Model Clinical Trials System for the 21st Century www.georgiacore.org www.georgiacancertrials.org REPORT A Model Clinical Trials System for the 21st Century A Response to the Institute of Medicine s 2010 Report A National Cancer Clinical Trials System