Download Overview of the FCT Programme

Faster Cancer Treatment (FCT)
- Improving quality of care across the
patient cancer pathway
CNC Orientation Forum
May 2013
FCT - Indicators
Indicator two (best practise – 14 days)
Urgent referral
with highsuspicion of
cancer
First specialist
assessment
Indicator three (best practise – 31 days)
Decision-to-treat
First cancer
treatment
Indicator one (best practise – 62 days)
Referred urgently with high suspicion of cancer receive first cancer treatment
within 62 days
Referred urgently with high suspicion of cancer have first specialist assessment
within 14 days
Confirmed diagnosis of cancer receive first cancer treatment within 31 days of
decision-to-treat
FCT Programme
• Current focus areas:
•
•
•
•
Regional Implementation Plans
National Tumour Streams
MDM development
Care Coordination
Regional FCT Implementation Plan
Review of existing IT systems / processes
identified:
• Difficult to connect events across the tumour
stream pathway especially when these pathways
span different DHBs and different services within
DHBs
• No single episode ID to support active patient
management or data reporting
• No consistent method to add a High Suspicion of
Cancer flag to enable prospective patient
management
Regional FCT Implementation Plan
Review of existing IT systems / processes
identified:
• Variations in interpretation of some data
elements will occur if business rules aren’t
agreed across the region (?nationally)
• Capture of these data elements currently is a
combination of PAS and paper based due to
variability in systems across the region
• Most PAS systems in the region are coming to the
end of their life therefore IT based solutions are
not feasible in the short term.
Regional FCT Implementation Plan
Period
Expected Processes
July 2012 to Dec 2012
DHB of Domicile compile FCT indicators based
on information provided by the various treating
DHBs
Mid Term
Regional consolidation with an emphasis on
automating processes where it is viable
Longer Term (2015+)
CRISP enabled information management,
national reporting framework supported by
national datasets and business rules
Regional FCT Implementation Plan
Data related activity:
• Reporting Framework
• CRISP design phase
• Suspected Cancer flags
• Data consolidation process
• External data eg Hospice
Currently in testing/development phase, first
report due Qtr3
Regional FCT Implementation Plan
• Planned Resources:
– 1.0FTE Regional Project Manager (CCN)
– 0.3FTE Regional data analyst (TAS)
– 1.0FTE FCT Tracker and 0.4FTE Clinical Advisor in
each of MDHB and CCDHB (major treatment centres)
– Funding for the regional data consolidation process /
tool
MOH confirmed funding - $335K for one year
DHB Execs approved plan
Positions being filled
FCT Components for CRISP
FCT Data
MDMs
Care Coordination
Concerto forms – capture of FCT
related information at a patient
level
VC Solution – implemented
Active patient tracking
including alerts when
breach imminent
E-referrals:
 High Suspicion of
cancer field - see MCN
work
 Referral criteria for
direct access to OP
colonoscopy
Flags in system:
 High suspicion cancer flag –
activated when secondary
clinician triages patients
 Diagnosis flag – activated
when confirmed diagnosis
comes thru
Sharepoint / National FTP site for
matching data across networks
Lab data – copy of lab report which
is sent automatically to NCR
Investigate CONCERTO, CANMAP & ischeduler as potential tools to
support:
 Scheduling patients to an MDM ? web based to enable visibility
outside of host DHB
 Data – capturing and reporting of
agreed datasets
 Communications – letters to GPs
patients, referrals
Map of Medicine – patient
pathways – see MDHB work
Non-surgical cancer
treatment IS
Scoping MOSAIQ across
region for MO and
Clinical Haematology
E-prescribing for
chemotherapy
Regional Data
Repositories / other
METRIQ – potential
data repository – see
SCN work
Endoscopy Quality
Improvement (EQI)
Programme – IT system
support eg Provation
FCT Regional Process
WhaDHB
TDHB
HBDHB
MDHB
WaiDHB
HVDHB
C&CDHB
Daily / Weekly
Monthly
No
Extracts data DAILY
from webPAS to
excel file
Discards Data
Appropriate
Data
Yes
Sorts Data
Accesses Access √
Database: Creates
SMT (Verifies patient
info)
Extracts data to access
database WEEKLY
from ward discharges
with cancer dx
Extracts data WEEKLY
from “internal DHB flow
chart” by excel
Verifies and updates
excel data (may add to
list)
Extracts data WEEKLY
from MOSAIQ to Excel
file
Reviews for
inclusion / exclusion
adds reasons and
dates
Reviews MDM list
and Pathology
Reports for FCT
patients
Receives Referral
Enters in IBA Sends
to Consultant
Adds patient to
Excel with dates
Consultant
Reviews patient
case Creates SMT
Adds patient info
to Clinical Tacking
Workspace
Downloads data from
SharePoint submitted
by other DHBs and
adds to workload
◄
Uploads data to
SharePoint
Verifies excel data
(may add to list)
Downloads data from
SharePoint submitted by
other DHBs and adds to
workload
√
Downloads data from
SharePoint submitted
by other DHBs and adds
to workload
Adds dates of FSA
into IBA
√
Reviews referrals, Surgical
list, and histology to
identify patients for FCT
Updates excel
√
Advisor (RN)
MDM Coordinator
Downloads data from
SharePoint submitted
by other DHBs and
adds to workload
Cancer Nurse
Coordinator
Pulls Quarter
Report for MOH
from SMT data
Downloads and uploads
data from SharePoint
for use
SharePoint
No upload at this time
Pulls Quarter
Report data from
excel for MOH
SharePoint
No download at this time
Pulls Quarter
Report data from
excel for MOH
SharePoint
No upload at this time
Pulls and formats
Quarter Report
data from excel for
MOH
SharePoint
No upload at this time
Flags Cancer Nurse
Coordinator Data is
due
√
√
Referral Centre
Compiles “questionable”
cases for Steering
!
Group review
Downloads data from
SharePoint submitted by
other DHBs and adds to
workload
Uploads data to
SharePoint
√
Adds Event in IBA
and links to
original referral
Tracker (Admin)
Reviews and
Corrects “Finished”
SMTs
Pulls “Finished”
data from SMT
Updates Access Data
Base
Key
Data Support
√
Scans and sends
referral to Cancer
Nurse Coordinator
Triages as FCT
sends back to
referral centre
Extracts data
MONTHLY for excel
Reviews SMT for
accuracy “Finish”
Quarterly
√
Cancer Nurse
Coordinator
Processes
√ Clinical
verification for
accuracy
◄ Tracking
Initiated
!
√
Pulls Quarter Report
for MOH from patient
admin system
Pulls data from system
Adds SharePoint data
Reviews for high level dates
Quarter Report data sent to MOH
SharePoint
No upload at this time
Escalation
process
Pulls Quarter
Report for MOH
from SMT data
No Clinical Review
at this time
National Tumour Streams
• Regional cancer networks contracted to host the
following national tumour streams:
•
•
•
•
NCN– Sarcoma, Upper Gastrointestinal, Melanoma, Head and Neck
MCN – Breast, and continue with Lung
CCN – Haematological
SCN – Bowel, Gynaecological
• Development tumour care standards and pathways
by June 2013
• Urological cancer tumour standards will be
developed following Prostate Cancer Task Force
recommendations to Government late this year.
MDM Development
Funding advice identified $2 million nationally for
MDMs - $455K CCN region
Next phase of activity:
• Implement the national Guidance for Implementing Quality
MDMs
• Transition to a video-conference environment
• Transition to regional electronic MDM proforma to allow:
– data collection as enabled by CRISP
– collection and reporting MDM data to provide baseline access
statistics
• Implement appropriate MDM coordination functions
• Develop a regional funding model
MDM Development
Videoconferencing suites – install completion
due end of Nov
Care Coordination
DHB
Capital and Coast
Hawkes Bay
Hutt Valley
MidCentral
Taranaki
Wairarapa
Whanganui
Minimum FTE
2.2
1.5
1.2
1.5
1
1
1
Care Coordination
CCN working with DHB Cancer Managers / DONs:
• Position descriptions
• Recruitment
• Orientation
• Networking
• Communications
• Workforce development
• Evaluation
Programme Governance
• Regional FCT Steering Group:
– Representation from relevant DHB executives, CRISP,
DHB managers, clinicians and consumers
– Determine what needs to be done from a regional
perspective, monitoring
• DHB FCT Implementation Steering Groups:
– Representation similar to above but at a local level
– Determine how things get done from a district
perspective,
Programme Governance
• FCT Data:
– Regional FCT Data Group
– FCT Trackers and Clinical Advisors Group
• MDM
– Upper Regional MDM Steering Groups (TDHB,
WhaDHB, MDHB, HBDHB)
– Lower Regional MDM Steering Group (C&CDHB,
HVDHB, WaiDHB)
• CNCI
– CNC Group
– DHB Cancer Managers and DONs Steering Group
– ?Expert Advisory Group
2014/15 Focus
• CRISP design to support FCT reporting and
patient tracking
• MDM – report access, move to BAU
• CNCI– support implementation and
evaluation
• Tumour standards – audit pathways