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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