Oncology Information System Innovation Centre at Health Sciences North. Steve Volpini Director, Clinical Informatics & IT Applications

Transcription

1 Oncology Information System Innovation Centre at Health Sciences North Steve Volpini Director, Clinical Informatics & IT Applications

2 Objectives Background Health Sciences North and NEON Northeast Cancer Centre Elekta & MOSAIQ Vision of Partnership Value proposition Governance & operational structure Initiatives Completed & Underway Challenges & Lessons Learned Future Opportunities

3 Geography, Catchment, Population Base LHIN13: is one of the largest of 14 LHINs in Ontario, responsible for planning, integrating and funding health care services for more than 565,000 people across 400,000 square kilometres (roughly size of Spain) HSN: Staffing of 3,900 employees, a medical staff of more than 250 & 600 volunteers with a diverse range of services across the following core programs: Medicine and Rehabilitation Diagnostic Services Critical Care Family and Child Emergency and Ambulatory Care Surgical Program Mental Health and Addictions Northeast Cancer Center

4 NEON North Eastern Ontario Network Consortium of 22 hospital partners and 3 Independent Health Facilities serving residents of north eastern Ontario. The consortium shares an electronic health record (Meditech), which paves the way for data accessibility so health care providers can better serve their patients. Goal is to create a single integrated record throughout Northeastern Ontario

5 The Northeast Cancer Centre of Health Sciences North (HSN) some basic facts HSNs Regional Cancer Program offering full Radiation & Medical Oncology services to LHIN13 Single Oncology Information System (OIS) Elekta MOSAIQ across LHIN 13. **First LHIN-wide single ambulatory Oncology deployment in Ontario** Health Sciences North/Northeast Cancer Centre Sault Area Hospital (SAH) & 13 other community chemotherapy satellite hospitals Radiation treatment administered in 2 sites (1 hub + 1 spoke), ~350km apart over WAN connection. **First satellite radiation treatment bunker in Canada using single OIS** Interfaces to Meditech systems (Hospital EMR) NEON 22 hospitals SAH Data extraction/submission capability CCO CIHI

6 Elekta - some basic facts Elekta is a Swedish healthcare vendor that provides radiation therapy hardware (linear accelerators, U/S, brachytherapy) and oncology information systems used in the treatment of cancer and brain disorders. Headquarters in Stockholm, Sweden More than 4000 employees worldwide Offices in ~ 40 countries (incl. Montreal & Toronto) Listed on the Nasdaq OMX Nordic Exchange since 1994

7 MOSAIQ: Elekta s OIS Operational in over 4,000 cancer centres, the MOSAIQ Oncology Information Management System is recognized as a best-of breed solutions. Full Clinical Functionality: offers all necessary functionality from Registration to Disease/Staging, Scheduling, CPOE to emar, Clin Doc, Automated Notifications and Workload Capture Chemotherapy Clinics Open System Architecture: offers flexibility, allowing sites to continue to integrate the hardware and software that meets their needs. Patients MOSAIQ Lab Testing Data Interoperability: offers compatibility with existing software solutions, permitting easy integration and migration of data (via HL7, DICOM or other). Connectivity (Regionalization): operates across physical locations, allowing a multi-site connectivity between healthcare organizations such as surgical sites and chemotherapy clinics. Cancer Care Site Radiation Bunkers

8 History of OIS in Sudbury 1990: Lantis for Radiation Treatment (record & verify), Cancer Care Ontario s (CCO) OPIS for MedOnc, scheduling, Disease Staging, etc : Filmless, paperless radiation oncology (incl. CPOE, MD assessments, inter-dept. communications) : Sunset of legacy OPIS system All functionality migrated to Elekta s MOSAIQ All mandated reporting requirements met through Elekta MOSAIQ CCO ALR, MIS, NACRS IQ Scripts initiated in Medical Oncology Drug eligibility & reimbursement 2011: Live with satellite radiation treatment facility (Sault. Ste. Marie) 2012: Partnership with Elekta to establish Innovation Centre

9 OIS in Sudbury: Current environment Hub & Spoke model Main site: HSN (Sudbury) All infrastructure located at main site (SQL db, App, Citrix) Single system fulfills all outpatient oncology requirements IT & Clinical application support provided Satellite locations Sault. Area Hospital: radiation oncology, medical oncology & practice management 1 RO from Sudbury travels, 1 Tx machine 4 MO onsite, chemo suite onsite Community Oncology Sites (14 community hospitals): emar, clinical documentation & practice management 40% of chemo administration occurs at COCN sites - Linear Accelerators (Sudbury & Sault Area Hospital Treatment Planning System (Sudbury) Connectivity - Sault Area Hospital Meditech - Sudbury Meditech - CT-Sim (Sudbury & Sault Area Hospital) - CCO (ALR, ISAAC) - CIHI (NACRS)

10 MOSAIQ Sudbury: Data flow Lab Results HL7 External Lab MOSAIQ SAH Radiation Therapy CT Linac Planning System Functionality Sudbury & Regional MEDITECH Lab Results HL7 DI/Path Reports HL7 EMR Link (Trt Summary) MIS Pt. Registration HL7 Scheduling CCO Databook, NACRs, MIS Patient Registration HL7 Disease Registration & Staging AJCC v7 (TNM) Transcription & Authentication of Oncology Notes Radiation Oncology CPOE Radiation Oncology Record & Verify - DICOM Radiation Oncology Clinical Documentation RTOG & CTCAE (NCI) v4 CITRIX Satellite Chemotherapy (14 Hospitals) Functionality Medical Oncology emar Medical Oncology Clinical Documentation Medical Oncology NDFP Documents HL7 Radiation Oncology Workload CCO Databook, MIS, NACRS (CIHI) ESAS Medical Oncology CPOE CCO Chemo Regimens & DIN Databook - ALR Sault. Area Hospital MEDITECH Lab Results HL7 Pt. Registration HL7 Documents HL7 Medical Oncology NDFP CCO Databook Medical Oncology emar - DIN Medical Oncology Clinical Documentation CTCAE (NCI) v4 Medical Oncology Workload MIS, CCO Databook, NACRS Databook RSTP MDS NACRS Data Warehouse ISAAC Db MIS Supportive Care Order Entry (Referral) EMR Link (Trt Summary) Supportive Care Workload MIS & CCO Databook Call-back System (Advance Calling System) DI/Path Report HL7 Medication Reconciliation - DIN

11 Common Vision: Shared by HSN & Elekta In an ideal world, the patient journey is simple and seamless however, new patients across Canada will take the cancer care journey across a disparately connected, heterogeneous and complex system... Prevention Screening Diagnosis Treatment Recovery Palliative Physician Clinic/ Family Practice Hospital Laboratory (e.g. mammography) Cancer Care Centre (medical and radiation oncology) Chemotherapy Radiotherapy Community Laboratory Hospice Host Hospital Surgery This disparity calls for seamless functionality and integration across the patient journey: Common Tools, Technology & Standards achieved through and Oncology Information System (OIS).

12 The Opportunity. Comprehensive Cancer Centres are quickly migrating to Elekta s MOSAIQ oncology solution Challenge: Elekta unable to meet demand for experienced implementation/support specialists, especially those with Ontario oncology experience. Health Sciences North (HSN) is viewed as a leader in Ontario in this space and has deployed the 1st regional solution to meet both clinical & data requirements within a single system HSN and Elekta propose partnership to create a MOSAIQ Innovation Centre which can ensure the system is current and world leading Consulting agreement whereby current resources & expertise would be supplemented in order to support some of provincial needs Create linkages to CCO provincial systems Create mobile applications for oncologists Improve next generation versions of MOSAIQ Develop, translate & share OIS best practices

13 Objectives of the Partnership The goals of the partnership are: Leverage Automation IQ Scripts HL7 CCO ALR extract Establish Standards within OIS System config &Data capture ESAS Process workflow (CPOE) Incorporate clinical BPG CCO eclaims QBP for Medical Oncology System development through application of Human Factors thinking

14 Anticipated Impact of the Partnership This initiative will lead to: Greater Availability Greater Adoption and Use Greater Interconnectivity Consistency in Standards Reducing cost of purchase and implementation, the greatest entry barrier, will allow more organizations to integrate software. A continuum of services, including education and training, will ensure that the systems are adopted to the fullest extent. Accelerate sites ability to exchange data by blanketing cancer care centres (from surgery to chemo sites with a software solution that meets the full spectrum of needs. Elekta celebrates CCO s Standards and a broad system introduction will ensure that all cancer care sites meet these standards and provide consistent and secure care to all patients.

15 Partnership Operations: Governance & Staffing Model Executive Committee Elekta Vice President Elekta Director Client Engagement HSN Vice President Cancer Services HSN Program Director HSN Project Management Steering Committee Elekta Director Client Engagement HSN Program Director HSN Project Management Operational Committee HSN Project Management Clinical Analysts Application Development IT Infrastructure IT Interop

16 Project Intake Process

17 Collaborative Projects 1. CCO Activity Level Reporting (*) -Data standards -Data extraction tool 2. Interface Mosaiq to CCO ISAAC (for ESAS) 3. NDFP / eclaims connectivity (*) 4. RO Careplans, Assessments & IQ Scripts automation in MOSAIQ 5. Systemic Therapy QBP (*) 6. Single Sign-on from MOSAIQ to ClinicalConnect portal. 7. Catalogue of MOSAIQ to Meditech interface specifications

18 CCO Activity Level Reporting (ALR) Data currently submitted to CCO via Activity Level Reporting (ALR) represents the basic set of data elements required to produce the quality, cost, and performance indicators for the cancer system. The data elements constitute patient level activity within the cancer system focused on radiation and systemic therapy services, and outpatient oncology clinic visits. Funding models for both Radiation & Medical Oncology driven based on data collected by CCO New Cases in RO New Cases in MO New Drug Funding Program Other indicators publicly reported (by site group, by MD, by facility) Wait times Volumes Stage Capture rate Symptom Assessment (ESAS)

19 CCO ALR (continued) Current State (provincially) No standard method to capture, audit, extract, submit data Data quality varies significantly Disparate manual processes site to site Ability to integrate new requirements limited Goal: Create a set of standards by which MOSAIQ sites may configure system and capture required data elements to satisfy ALR. Create an extract script to connect to any MOSAIQ system. Deliverables: Standard MOSAIQ -ALR specification Available across versions of application Front-end (application) & back-end (database) mapping document. Necessary to talk to both clinical analysts & IT Knowledge transfer to local analysts/it/informatics resources Extract script connectivity to Test & Production platforms some configuration required!! Ability to reach 100% standardization? Good luck! Tool may be customized but beware Status: In use in Sudbury, Thunder Bay Pilot at Juravinski Cancer Centre (Hamilton) & Odette Cancer Centre (Sunnybrook) Potential future sites: Windsor, Ottawa, Southlake, PMH, Lakeridge

20 eclaims HL7 v3 connectivity to Cancer Care Ontario CCO New Drug funding Program The New Drug Funding Program (NDFP), created in 1995, is a publicly funded drug program under the Ontario Public Drug Programs (OPDP). NDFP directly covers the cost of many newer, and often very expensive, injectable cancer drugs administered in hospitals and cancer centres. Funding eligibility based on CCO form completion (by Oncologist) Enrollment & Treatment data submitted to CCO monthly for reimbursement Current State (provincially) No standard method to capture, audit, extract, submit data Variety of manual process, differing from site-to-site: MD needs to remember to fill in enrollment info based on selected Care plan MD fills in form on paper, clerk/pharm tech transcribes into CCO system Significant duplication, data quality varies significantly Potential for delayed or lost $$ reimbursement Ability to integrate new requirements limited

21 eclaims HL7 v3 connectivity continued Goal: Integrate seamlessly with minimal changes to workflow Little or no impact to physicians Minimize or eliminate duplicate data entry relating to NDFP-sponsored drugs Provide status reporting Leverage Human Factors thinking User-Friendly Prompts, messages Avoid use of Technical Jargon Process in place for manual submission, as needed Optimize the # of mouse clicks Pre-population of data where possible Supporting documentation attached later Deliverables: 2 separate HL7 v3 bi-directional interfaces b/w MOSAIQ & CCO eclaims Eligibility Treatments

22 Project Timeline Initial Project Discussions and Planning Initial Business Requirements Discussion (8/22) UAT Connectivity Established (12/10) PIA/TRA Team Assembled (12/13) UAT Completed (1/20) Live Connectivity Established (3/7) Initial Physician Launch (4/15) eclaims Live NECC (4/30) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr CCO eclaims Web App Launch Treatments Interface Launch Enrolments Interface Launch Treatments Auto-Submitted 22

23 MOSAIQ-eClaims Enrollment Integration Workflow 23

24 Medical Oncology CCO eclaims Interface IQ Script

25 Medical Oncology CCO eclaims Interface IQ Script

26 Medical Oncology CCO eclaims Interface IQ Script

27 eclaims Application

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30 back in MOSAIQ Once the physician completes the information in CCO eclaims the physician will finish applying the Care Plan and a notification is auto-applied & sent to NDFP Office location. QA can be completed by the Pharmacy Technician and any necessary supporting documentation can be uploaded to eclaims

31 eclaims Interface - Current Status Fully live in Sudbury since April 2014 Scheduled rollout to Southlake CC Treatments interface Summer 2015 Enrolments interface Fall/Winter 2015 Subsequent sites: Niagara, Thunder Bay Early 2016 Both sites live or piloting provincial ALR extract tool standardized configuration of system already achieved.

32 QBP - Systemic Treatment (ST) Funding Model April 1st, 2014, a new ST funding model was introduced. Funding impact for FY2015/16 for the systemic programs This new direction in funding will also have an effect on Radiation Treatment Programs in the near future. Conventional model of ST funding: Not reflective of actual activities/treatments done: 1 lump sum based on New Patient No standardization: CCO s Activity Level Reporting data demonstrates significant practice variation amongst ST care providers throughout Ontario. The new model: Patient-centred funding model: funding received based on activities/treatments applied Based on evidence-informed practice (QBP Quality-Based Procedures)

33 Systemic Treatment Funding Model

34 Systemic Treatment Funding Model

35 ST Funding Model Operational Report Cancer Care Ontario provides each Cancer Centre with a monthly Operational Report: Detailed breakdown of the ALR data submissions Provides information about the volumes of activity that will not be funded in the new model Provides opportunities for improvement by identifying potential data quality and/or clinical practice issues

36 Medical Oncology Care Plans in MOSAIQ Care Plan functionality used in MOSAIQ to prescribe and record the treatment of chemotherapy regimens (IV and non-iv).

37 Medical Oncology Care Plans in MOSAIQ Adding a Care Plan:

38 Medical Oncology Care Plan Audit Report Custom Crystal Report accessed through MOSAIQ QBP Data included in Report This report can identify: Funded Evidence Informed Regimens Unfunded Regimen Activities: Non Evidence-Informed Regimens Miscoded Intent Unfunded for Disease The report is run daily looking at new Care Plans added the previous day. Goal is to fix data quality issues prior to the patient starting treatment The report is provided to the Lead Medical Oncologist for investigations of non-evidence informed practices.

39 Medical Oncology Audit Report Funded Activities

40 CCO Non Evidence-Informed

41 Unfunded (Miscoded) Intent

42 Unfunded Disease

43 Going Forward QBP for ST CCO s Clinical Practice Group Mapping: Mapping is currently under review by CCO for identified mapping issues. This will have to be updated in our database whenever a new version is available. ST Funding Model Master List of Evidence Informed Regimens: As CCO updates the Operational Report with new regimens, this master list is edited and updated in our database. No need for Elekta to perform any changes to currently available system. All changes to CarePlans & Order Sets including the CCO disease site group supported by current versions of the system. Model for ST QBP presented at Elekta Users Meeting Feb 21 for user input. Model to be documented and made available to 3 other Mosaiq MO sites (Thunder Bay, Southlake, Niagara) by June 2015 given the need for additional automation & QA tools.

44 Challenges & Lessons Learned No control over local change management reliance on executive support Manage the expectation of the customer. You re now a vendor of services! Balance of Operations & Projects matrix environment role confusion (especially in clinical program) Need for workload management given dual reporting value to customer Balance of standardization vs. customization When is it ok to be different? Need to engage sites sooner in their process of standardization

45 Future Opportunities Re-evaluate the balance of Product development vs. Service deployment as our key business Provision of expanded scope of services for Elekta customers Project Management Process Analysis Change Management Education

46 Thank you.