Download Midland Faster Cancer Treatment Implementation Plan 2012 – 2013

D
Midland Faster Cancer Treatment
Implementation Plan 2012 – 2013
Version: Final
Midland Faster Cancer Treatment Implementation Plan, September 2012
Document control
Sign off sheet
The following signatures indicate approval and acceptance of the Midland FCT Implementation Plan.
Name
Craig Climo
Role
Signature/Date
Chief Executive, Waikato
DHB
____________________ ____/____/____
Phil Cammish
Chief Executive, Bay of
Plenty DHB
____________________ ____/____/____
Jim Green
Chief Executive, Tairawhiti
DHB
____________________ ____/____/____
Ron Dunham
Chief
DHB
____________________ ____/____/____
Executive,
Lakes
L:\Midland_Cancer_Network\Service Improvement Initiatives & Projects\Faster Cancer Treatment\FCT Implementation Plan Final\2012-10-15_ FCT
Regional Implementation Plan Final.doc
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Table of Contents
1
2
3
Executive summary ....................................................................................................................... 1
Introduction .................................................................................................................................... 4
Faster Cancer Treatment programme.......................................................................................... 4
3.1.1 National tumour stream working groups ................................................................................. 5
3.1.2 Cancer care coordination........................................................................................................ 5
3.1.3 Cancer multidisciplinary meetings .......................................................................................... 5
4 Scope .............................................................................................................................................. 5
5 Midland FCT Implementation Plan ............................................................................................... 6
5.1
Approach and timeline .............................................................................................................. 6
5.1.1 Key principles.......................................................................................................................... 7
5.1.2 Critical success factors ........................................................................................................... 8
5.2
Governance and management ................................................................................................. 8
5.2.1 Governance structure ............................................................................................................. 8
5.2.2 Clinical leadership and engagement ...................................................................................... 8
5.2.3 Service management.............................................................................................................. 9
5.2.4 Communications ..................................................................................................................... 9
5.2.5 Monitoring and reporting......................................................................................................... 9
5.3
Information systems - current state .......................................................................................... 9
5.3.1 National IS programme........................................................................................................... 9
5.3.2 Midland Regional Information Systems .................................................................................. 9
5.3.3 Midland DHB information systems........................................................................................ 10
5.4
Projected future requirements ................................................................................................ 12
5.4.1 Information systems changes ............................................................................................... 12
5.4.2 High level summary of proposed DHB changes 2012-13 .................................................... 13
5.4.3 People................................................................................................................................... 13
6 Action Plan ................................................................................................................................... 14
6.1
FCT indicator reporting ........................................................................................................... 14
6.2
Wider FCT programme........................................................................................................... 16
6.3
Investment approach and cost ............................................................................................... 16
6.4
Risk management................................................................................................................... 17
Appendix A: Midland Cancer Network regional initiatives ............................................................. 19
Appendix B: Regional information systems funding ...................................................................... 21
Midland IS Executive Minutes - Faster Cancer Treatment Indicators ............................................... 21
Draw down process ........................................................................................................................... 21
Appendix C: DHB information systems – current and future state ............................................... 23
Current state ...................................................................................................................................... 23
Projected future state ........................................................................................................................ 25
Appendix D: DHB and regional approaches/data flows.................................................................. 28
Lakes ................................................................................................................................................. 28
Tairawhiti ........................................................................................................................................... 29
Bay of Plenty ..................................................................................................................................... 35
Waikato/Midland region ..................................................................................................................... 39
Appendix E: Midland FCT Work Group............................................................................................. 40
Appendix F: Glossary of Terms......................................................................................................... 41
L:\Midland_Cancer_Network\Service Improvement Initiatives & Projects\Faster Cancer Treatment\FCT Implementation Plan Final\2012-10-15_ FCT
Regional Implementation Plan Final.doc
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
1 Executive summary
This Midland Faster Cancer Treatment Implementation Plan 2012-2013 has been prepared on behalf
of the Midland DHBs (Bay of Plenty, Lakes, Waikato and Tairawhiti) for submission to the Ministry of
Health (due November in order to release first tranche of funding). This plan has a lot of detail to
support sector stakeholders who have found it difficult to understand the complexity and context of the
Faster Cancer Treatment indicators and the wider cancer control programme.
The Faster Cancer Treatment indicators are:
The intention of this implementation plan is to support robust regional DHB data collection and
reporting with a phased approach within a three year timeframe. This implementation plan addresses
phase one, being 1 July 2012 to 30 June 2013. Currently DHBs are unable to identify people with
suspected cancer, or those with a cancer diagnosis and where they are within the secondary-tertiary
journey.
The Midland Cancer Network Executive Group will constitute the regional steering group for the
implementation of FCT indicators. Monitoring of progress will be undertaken by the Midland Cancer
Network Executive Group. The Midland FCT Work Group that was formed to develop this plan will
come together to work on implementation as required. The Network manager (or delegate) will chair
this group. The regional FCT project/change management resource and business analyst is required
to support the regional DHBs for the duration of this implementation plan. Reporting will be via the
Midland Regional Clinical Services Plan and any other Ministry of Health contractual agreements that
are as a result of this implementation plan.
Regional IS are a strategic partner and enabler within this plan. Midland has an IS governance
structure and programme that the Midland Cancer Network links into. FCT indicators have been
prioritised in the Midland IS work programme.
The network has facilitated a review of the current state of DHB information systems capability to
report the FCT indicators and identified the preferred future state.
The Midland approach includes:
• local DHB solutions to capture and collate FCT indicator data elements utilising technology,
people and/or processes
• regional FCT database for:
o Midland Cancer Network DHBs to submit data
o DHBs outside of the Midland region to submit data
o regional report back to other DHBs outside of Midland for those patients treated
within Midland
• build regional expertise for:
o report consolidation back to Midland DHBs and relevant narrative
o quality assurance, audit and control of data
o standardised reporting and monitoring
o supporting regional clinical audit and reporting back on specific areas of focus for
service improvement
o links to other regional cancer networks and DHBs
o links with National Cancer Team
• resources are required at local and regional level to support technology changes to DHB
information systems and people to collect and collate data not captured in DHB information
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 1 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
systems. These resources include nurse cancer tracker positions in DHBs and a regional
FCT project manager and business analyst.
The detail related to individual DHB plans to meet reporting requirements are contained within the
appendices to this document. In summary:
Bay of Plenty
The current comprehensive plan has been developed in consultation with clinicians, to make changes
in DHB systems to collect data elements with the exception of reason for delays for each indicator. It
is expected that this will be addressed as work proceeds.
Lakes
Some data elements will be collected in iPM. There is no plan to make changes to iPM in 2012-13
other than add a high suspicion of cancer flag. The reason for this is that the scope of a planned
upgrade to iPM has been signed off and no further changes can be implemented until this is
completed. A cancer nurse tracker will be required to coordinate manual data collection.
Tairawhiti
A FCT register has been developed in iPM which will require a cancer nurse tracker to enter all data.
All the key data elements are able to be collected but it does not record external referrals to treating
DHBs. Manual data entry has commenced.
Waikato
A high level requirements document has been completed by Waikato IS outlining changes required to
extract data from standalone databases and the PMS into a staging database. Provision has been
made for the manual data entry of delay reasons. Development of this solution has been scheduled
for November 2012.
Regional FCT database
Waikato DHB IS will develop and host a regional FCT database where Bay of Plenty, Lakes,
Tairawhiti and Waikato DHB extracts can be consolidated and relevant wait times information
reported back to the DHB of domicile. Data extracts from non-Midland DHBs will also be incorporated
in the consolidation process. The Midland Cancer Network Business Analyst will be responsible for
data consolidation and reporting.
Investment approach and cost
Some funding was initially allocated by the Ministry of Health with the Midland DHB’s contribution
through the Midland Information Services Executive. An additional review of this plan in September
by the Ministry of Health has resulted in additional funding of $145,000 being made available.
Summary of funding for Midland FCT Implementation Plan
Source
To be used for
Ministry of Health
IS and non-IS allocation
Midland DHBs’ contribution through
Regional IS prioritisation. Does not
include contribution of DHB staff as part
of business as usual
IS
Ministry of Health
Non-IS allocation
Total
2012-10-15_ FCT Regional Implementation Plan Final.doc
Funding
$215,000
$50,000
$145,000
$410,000
Page 2 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Allocation of funding for Midland FCT Implementation Plan
Organisation
To be used for
Responsibility
Funding (up to)
Midland Cancer
Network
Regional FCT database
Regional
IS/Waikato IS
$45,000
Waikato DHB
HSC flag implemented; new
data extract routines;
staging database and DHB
FCT database
Waikato IS
$41,000
Lakes DHB
No changes planned to iPM
but funding required for
data matching
Lakes IS/Decision
Support
$32,000
Bay of Plenty DHB
Development and
implementation of changes
to WebPAS
Business
Intelligence Unit
$65,000
Tairawhiti DHB
FCT Register built within
iPM with manual data entry
CIO
$20,000
Midland Cancer
Network
Regional project manager
and
Analyst
Midland Cancer
Network
$60,000
Waikato DHB
Cancer nurse tracker
COO
$63,000
Bay of Plenty DHB
Cancer nurse tracker
COO
$42,000
Lakes DHB
Cancer nurse tracker
COO
$28,000
Tairawhiti DHB
Cancer nurse tracker
COO
$14,000
Total
$410,000
This implementation plan includes an action plan that will guide Midland Cancer Network staff in
facilitating and supporting Midland DHBs to achieve the IS changes necessary to undertake reporting
of the FCT indicators. Mandatory reporting of the FCT indicators to the Ministry of Health is required
on a quarterly basis from April 2013 (for Quarter 3) but it is envisaged that “dry runs” will occur in
Quarter 2 working retrospectively from chemotherapy and radiotherapy treatment data.
In turn, reporting the indicators will assist DHBs to improve timely and appropriate access to
secondary/tertiary services with the ultimate aim being to improve patient outcomes. The reporting of
the FCT indicators is not the ultimate outcome.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 3 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
2 Introduction
This Midland Faster Cancer Treatment Implementation Plan 2012-2013 (implementation plan) has
been prepared by the Midland Cancer Network on behalf of four Midland DHBs (Bay of Plenty, Lakes,
Waikato and Tairawhiti) for the Ministry of Health.
The Faster Cancer Treatment work programme is to support robust regional DHB data collection and
reporting against the indicators with a phased approach over a three year timeframe. This
implementation plan addresses phase one, being 1 July 2012 to 30 June 2013. During this period the
DHBs will work to establish baseline data, using retrospective reporting, against the three faster
cancer treatment (FCT) indicators with mandatory reporting from Quarter 3 2012-13. Subsequent
activities will be directed toward robust capacity building, including information systems capacity, to
support ongoing collection according to the nationally agreed data definitions and criteria.
Currently DHBs are unable to identify people with suspected cancer, or those with a cancer diagnosis
and where they are within the secondary-tertiary journey. Reporting the indicators is to assist DHBs
to improve timely and appropriate access to secondary/tertiary services with the ultimate aim being to
improve patient outcomes. The reporting of the FCT indicators is not the ultimate outcome.
The document describes how the implementation plan is to be governed, managed and delivered.
This plan will be reviewed quarterly and is the basis on which DHBs are to be held accountable for the
collection of the FCT indicators. Stakeholders are encouraged to work collaboratively to both identify
and resolve issues as they arise.
The primary audience for this implementation plan are the Midland DHB Boards and executive/clinical
teams, regional and local DHB information systems managers, information management teams,
decision support staff, and cancer continuum services clinicians and managers.
3 Faster Cancer Treatment programme
The implementation of the FCT indicators (the indicators) was identified as a priority for DHBs in the
2012/13 DHB Planning Package. The implementation of the indicators has also been endorsed by
the Cancer Programme Steering Group (CPSG), and the Cancer Treatment Advisory Group (CTAG).
Faster Cancer Treatment (FCT) is a patient pathway approach to ensuring timely clinical cancer care
and will be measured by the following agreed indicators, for patients:
•
referred urgently with a high suspicion of cancer receive their first cancer treatment (or other
management) (best practice timeliness measure of within 62 days)
•
referred urgently with a high suspicion of cancer have their first specialist assessment (best
practice timeliness measure of within 14 days)
•
with a confirmed diagnosis of cancer to receive their first cancer treatment (or other
management) from decision-to-treat (best practice timeliness measure of within 31 days).
This FCT programme supports the joint Ministry of Health and DHB National Cancer Programme’s
vision for all people being able to access the best services in a timely way to improve overall cancer
outcomes. The focus areas of the National Cancer Programme are:
•
wait times: all people get services in a timely manner
•
access: all people have access to services that maintain good health and independence
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 4 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
•
quality: all people receive excellent services wherever they are
• financial sustainability: all services make the best use of available resources.
During 2012-13 the DHBs will work to establish baseline data, using retrospective reporting, against
the three FCT indicators. The nature of the reporting against the FCT indicators will change, with the
retrospective reporting moving to real-time monitoring of each patient progressing through the
pathway in the future.
The FCT work programme is supported by:
• development of tumour stream standards, patient pathways and service frameworks
• additional cancer care coordinators
• improved cancer multidisciplinary meetings.
3.1.1 National tumour stream working groups
Timed, effective pathways based on tumour specific quality standards ensure that:
•
patients receive timely and good quality care throughout their cancer journey
•
patients receive the same standard of care regardless of where they live
•
efficient and sustainable best practice management of specific tumour types is developed in
the New Zealand health system
a nationally coordinated and consistent approach to service provision for the tumour type is
promoted.
Eight national cancer working groups have been established for one year to develop tumour
standards, patient pathways and a service framework to support the FCT approach: breast (Midland
Cancer Network); bowel and gynaecological (Southern Cancer Network); head and neck, melanoma,
upper gastro-intestinal and sarcoma (Northern Cancer Network); haematological (Central Cancer
Network). Midland Cancer Network already hosts the National Lung Cancer Working Group
programme.
•
3.1.2 Cancer care coordination
The regional cancer networks undertook a stock take of secondary/tertiary cancer care coordinators
in June 2012. This provided baseline information related to the Minister’s 2012 cancer budget
announcement of new sustainable funding for cancer nurse coordinators. 7.3 FTE has been allocated
for the Midland Cancer Network DHBs.
3.1.3 Cancer multidisciplinary meetings
Best practice cancer multidisciplinary meetings support achievement of the FCT indicators. The
network has invested one-off funding to upgrade the audiovisual equipment in the radiology
conference rooms where many MDMs are held at Waikato, Tauranga and Rotorua Hospitals. This is
in preparation for HD video conferencing across the region. Midland IS has prioritised funding for
videoconferencing endpoints in 2012-13 with implementation expected by December 2012.
The Ministry of Health announced DHBs were to reinvest pharmacy savings for cancer MDM
development from 1 July 2013 and has released a best practice guidance document. The Midland
GMs Planning and Funding are collaborating with the network in the prioritisation of this funding.
Other 2012-13 Midland Cancer Network priorities that are to be implemented alongside the FCT work
programme are outlined in Appendix A: Midland Cancer Network regional initiatives.
4 Scope
The scope of the FCT indicators in this implementation plan concurs with nationally agreed
inclusions/exclusions.
In scope:
•
all Midland DHB adults that are referred to secondary and tertiary public health services with
a high suspicion of cancer
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 5 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
•
all Midland DHB adults with a diagnosis of cancer and receive secondary and tertiary public
health services
•
private providers and/or NGOs that are publicly funded to provide treatment services for those
with high suspicion of cancer and/or those with a diagnosis of cancer
• data points clarified e.g. collection starting point and reporting requirements for 2012-13.
Out of scope:
Patients are excluded from the FCT indicators if the patient:
• has a post decision-to-treat pathway that begins outside the New Zealand public health
system
• has cancer diagnosed as an incidental finding at the time of treatment
• was referred urgently for a first specialist assessment for high-suspicion of cancer, which
resulted in no confirmed diagnosis of cancer
• has low risk non melanoma skin cancer
• has non-invasive or non-malignant (benign) tumours
• has low-grade, asymptomatic or indolent haematological malignancies
• is referred and accepted by child cancer services.
5 Midland FCT Implementation Plan
5.1
Approach and timeline
Date
Action
27 January –
10 February
Ministry of Health request to New Zealand regional cancer networks to submit a
joint high level project plan – development of tumour stream standards and
patient pathways project. This required agreement from the four network clinical
directors, network managers and endorsement from the four lead DHB CEOs
April 2012
Ministry of Health Faster Cancer Treatment indicators: data definitions and
reporting for the indicators published along with frequently asked questions and
reporting template
12 April
Regional communication and formation of Midland FCT Work Group.
Recruitment started for FCT project resource and business analyst (fixed term)
12 April–16 April
Ministry of Health contract agreements signed for the Faster Cancer Treatment
Implementation Plan, regional stocktake of care coordination and national
tumour stream working groups
18 May
Regional FCT Work Group meeting – overview of requirements, project plan
endorsed, stocktake template agreed and timeframe due for completion 15/6/12
20 May
FCT Implementation progress report to Ministry of Health
18 June
Ministry of Health notification FCT reporting change to DV1 developmental
measure to establish baseline for faster cancer treatment. The reporting
frequency is to reduce from monthly template submission to quarterly template
submission
22 June
Regional FCT Work Group meeting; Ministry of Health present. Review of
stocktake findings, issues and agreed approach to solutions
6 July
Midland and Northern FCT Implementation Plan presentations and meeting with
Ministry of Health Cancer Team and National Health IT Board
24 July
Regional IS advised that “any money we get from MoH for FCT IT components
needs to go through the regional IT prioritisation for distribution. While DHBs
have given their own IT estimates IT is prioritised and funded regionally”
27 August
Ministry of Health advice re allocation of funding of $215,000
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 6 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Date
Action
August-September
Midland Cancer Network data analysis of 2011 DHB cancer registrations to
retrospectively match patient journeys, identify issues and apply learning to
inform this plan
13 September
Midland IS Executive meeting – responsibility for the IS changes will sit with the
Regional CIS programme. Process for each DHB to drawdown funds advised
25 September
Further MoH review of implementation plans completed with additional funding
confirmed on 15 October.
5.1.1 Key principles
Principles that informed the development of the implementation plan included:
•
a patient centred approach - the person with suspected cancer and/or with a diagnosis of
cancer requiring treatment is the centre of this plan
o the implementation plan changes will assist the improvement of cancer patient
journeys and their experience
o timely access to services which will ultimately lead to improved outcomes
o contributes towards reducing inequalities with respect to timely access to cancer
treatment services, able to be measured by ethnicity
•
strategic alignment with national and regional plans and supporting infrastructure i.e. clinical
service plans and information system plans
o regional DHBs able to absorb and cope with national tumour standard developments
•
financial sustainability - investment into technology, people and process changes can be
achieved within the national funding available
o DHBs have indicated due to financial constraint there is no/limited ability to allocate
new or reprioritise funding
o sufficient resources to support the FCT wait time indicators programme
o Regional IS can support and enable FCT indicator reporting and cancer MDM
development
o business process/change is manageable and not disruptive
o DHBs are able to adapt and evolve as data definitions and reporting requirements
change – the amount of national change is kept to a minimum to minimise impacts on
DHBs financial and resourcing capacity. The Ministry of Health suggested three
month notification of changes – there needs to be change management resource to
support this requirement
o sufficient resource allocated to change management to understand and interpret non
compliance with wait time standards, including managing public expectations
o enable creation of a FCT episode of care
o solutions found for gaps in data collection
•
clinician led approach to support FCT and service improvement – that the technology, people
and process changes related to the implementation plan
o provide value to clinicians and support improved clinical interactions
o do not impact on clinical time and patient care
o enter and capture data once
o clearly locate the responsibility of FCT collection and reporting with DHBs
•
cancer care is coordinated – to enable consistency and coordination across tumour streams
and across the cancer continuum
•
cancer MDM approach to improve patient care and outcomes - necessary improvements are
made
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 7 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
•
1
regionalisation principles – where funding is required, unless a funding stream is identified
the work will not be able to be undertaken.
5.1.2 Critical success factors
A critical success factor for implementation of FCT indicators is regional funding to build capacity and
capability supported by:
•
clear and concise national data definitions with supporting business processes and rules
•
submission of data in accordance with the Ministry of Health performance indicator
requirement reporting
•
developing and improving the FCT indicator process and data quality within the region
•
an agreed regional approach to reporting FCT to Ministry of Health quarterly
•
collection and reporting of data by patient domicile DHB being provided in a timely and
consistent manner
•
resources allocated to make the local DHB technology changes required to enable real time
patient data capture and IS enable DHB systems and infrastructure to support clinicians (not
in 2012-13).
5.2
Governance and management
5.2.1 Governance structure
The Midland DHBs own and manage the implementation of the FCT indicators as a means to
understand and improve the patient journey for their population. The Midland Cancer Network
Executive Chair (also Waikato DHB Chief Operating Officer) and Midland Chief Information Officer are
the executive sponsors of the implementation plan. Responsibility for the FCT Implementation Plan
sits with the Midland Cancer Network.
The Midland Cancer Network Executive Group will constitute the regional steering group for the
implementation of FCT indicators and will monitor progress.
The Midland FCT Work Group that was formed to develop this plan will come together to work on
implementation as required. The network manager (or delegate) will chair this group.
Regional FCT project/change management and business analyst resource is required to support the
DHBs for the duration of this implementation plan.
Reporting will be via the Midland Regional Clinical Service Plan and the Ministry of Health contractual
agreement.
Regional IS are a strategic partner and enabler within this plan. Midland has an IS governance
structure and programme that the Midland Cancer Network links into. Responsibility for the IS
changes sits with the Regional CIS Programme.
The Midland Region Information Services Portfolio Management Framework (March 2012) outlines
the governance structure and links with Midland DHBs and the Midland Cancer Network.
5.2.2 Clinical leadership and engagement
Clinical leadership and engagement is achieved as follows:
•
each DHB has a local FCT team. Each DHB will be responsible to ensure that there is
clinician engagement and leadership for the FCT implementation
•
regional clinical leadership will be provided by the network clinical director and clinical chair
leads. The Midland clinical chairs are part of the Midland Cancer Network Executive Group
•
consultation with clinicians will continue as part of the network’s regional tumour (e.g. lung,
breast, bowel) and service specific (Adolescent and Young Adult Cancer Service, radiation
oncology, medical oncology, palliative care and clinical nurse specialist/care coordinator)
work groups.
1
Regionalisation has one or more elements of a single non-clinical or clinical service between two or more DHBs and does not
mean centralisation (Midland DHBs, June 2012)
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 8 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
5.2.3 Service management
The DHB FCT service manager leads have management accountability for the FCT implementation in
each DHB and will sit on the Midland FCT Work Group. They will provide service management
leadership and will be responsible for developing DHB management engagement with the FCT
implementation.
The DHB FCT nurse cancer tracker will report to the FCT service manager lead in each DHB.
Local DHB IS staff and business analysts will form part of the local DHB FCT team and participate in
the Midland FCT Work Group as required.
5.2.4 Communications
A communication plan has been developed.
5.2.5 Monitoring and reporting
The network manager is responsible for the reporting related to the implementation plan as per the
Ministry of Health agreement and service specification. Other reporting includes:
•
quarterly FCT reports to the Midland DHBs with narrative
•
quarterly reporting to Midland Cancer Network Executive Group and Regional Service Plan
reporting
•
six monthly Midland Cancer Network reporting to the Ministry of Health
•
regular updates to Midland chief operating officers and GMs planning and funding and other
regional forums as required.
The Midland FCT project manager and business analyst will provide monthly reports to the network
manager and quarterly report to Midland Cancer Network Executive Group on:
•
performance and compliance against milestones
•
risk register reporting
•
issues register reporting
•
audit reports
•
change request reports.
5.3
Information systems - current state
5.3.1 National IS programme
In the short term, the FCT work programme is not supported by any national information systems
work priority (Ministry of Health email 26/6/12), nor can we find that it is a prioritised focus area in the
National Health IT Plan. In the medium term, the Ministry is developing a National Patient Flow
Collection that will capture health events that people experience in the publicly funded health system.
“The National Patient Flow Collection will automatically provide data to enable DHBs to report against
the FCT indicators” (Ministry of Health, 31 May 2012).
For this reason, the Ministry of Health advice to regions is for DHBs to spend no more than they need
to on collecting the data required for reporting the indicators.
For 2012/13, the Ministry of Health allocated $1 million in funding for DHB information system
improvement for FCT based on the needs identified in the implementation plans.
5.3.2 Midland Regional Information Systems
The Clinical Information Services (CIS) Programme is responsible for delivery of a number of regional
priority initiatives over the next few years:
•
clinical workstation
•
clinical data repository
•
medications management
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 9 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
•
eReferrals
• maternity.
The Midland Cancer Network submitted an executive brief to the Midland Information Services
Executive Group for 2012-13 prioritisation for funding for implementation of FCT indicators. In
September $50,000 was approved and the Regional CIS Programme will be responsible for the
drawdown of this funding as well as $153,000 from the Ministry of Health allocation to fund all IS
changes. The Midland CIOs have been advised of the process for drawing down this funding. See
Appendix B: Regional information systems funding.
5.3.3 Midland DHB information systems
Key gaps and issues relating to current system’s ability related to data capture in patient management
systems (PMS) and data flows include:
• no patient tracking system for those referred with high suspicion of cancer and for those
receiving treatment
• current ‘shorter waits for cancer treatment’ health target reporting occurs from standalone
databases/information systems
• some FCT data elements will require manual collection/data entry depending on the DHB
PMS and their planned improvements
• no mechanism to share information between DHB of domicile and DHB of service
• data from publicly funded private providers and NGOs may not be available.
Summary of current state
Data Element
Meets regional
requirements?
Notes
Ethnicity
Yes
DHB of domicile
Yes
DHB of receipt of
referral
Captured at DHB of domicile; not visible to DHB of
service if different.
No
Date of receipt of
referral
Captured at DHB of domicile; not visible to DHB of
service if different.
No
High suspicion of
cancer flag
Not available.
No
Date of FSA
Primary site ICD
Date of decision to
treat
Type of first treatment
Date of first treatment
Difficulties around data flows from private
providers (e.g. Urology).
Only recorded for inpatients having surgery or
radiotherapy.
This data is generally recorded at DHB of service
but not visible to DHB of domicile. Differences in
interpretation require clear and consistent business
rules.
Generally recorded at DHB of service, but not
visible to DHB of domicile. In all cases, difficult to
obtain data on treatments other than surgery,
chemotherapy or radiotherapy.
Generally recorded at DHB of service, but not
visible to DHB of domicile. In all cases, difficult to
obtain data on treatments other than surgery,
chemotherapy or radiotherapy.
Yes
No
No
No
No
DHB of service for first
treatment
Not recorded in all cases.
No
Delay reason code
Not recorded, and would not currently be visible to
DHB of domicile if patient being treated elsewhere.
No
NHI
2012-10-15_ FCT Regional Implementation Plan Final.doc
Yes
Page 10 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Data Element
Age
Episode ID
Meets regional
requirements?
Notes
Yes
Unique numbers can be generated currently, but
become useless if other service providers are
involved. Only feasible if regional database is
created and used.
No
Source of referral
Yes
Urgency of referral
Date patient informed
of diagnosis
Date of most valid
diagnosis
Yes
Date of MDM
No
Can be obtained for inpatients only.
No
MDM data not stored consistently, or accessible in
all cases.
No
See Appendix C: DHB information systems – current and future state, for more detailed information.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 11 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
5.4
Projected future requirements
5.4.1 Information systems changes
From a systems’ perspective, the following changes will need to occur if the region is to meet its FCT reporting obligations. Further detail is in Appendix C:
DHB information systems – current and future state.
Item
High suspicion of cancer
DHB of receipt of referral
Date of receipt of referral
Primary site ICD
Date of decision to treat
Description
New field required to capture high suspicion of cancer (flag)
Business rule agreed and implemented ensuring definition and process is
consistent. DHBs have agreed that this can be flagged at point of referral, but can
later be altered/confirmed at triaging by SMO
Business process required to ensure that service provider (external DHB or private
provider) has visibility of initial referral date and where it has come from
Diagnostic data should be obtained from pathology if no information currently exists
(outpatients; treatments not currently captured in health target reporting).
Mechanisms to obtain this information quickly and easily should be implemented –
however timely access to the MOH Datamart is not an option.
Business process required to ensure that decision to treat information is reported
back to DHB of domicile
New data point required to identify where treatment is NOT radiotherapy,
chemotherapy or surgery
Domain
Data capture
Owner
All DHBs and PHOs
Business
process
All DHBs
High
Data flow
All DHBs
Medium
Data capture
All DHBs
High
Data flow
Data capture
DHBs & private
providers
DHBs & private
providers
Priority
High
Medium
Low
Type of first treatment
Business process required to ensure treatment details are reported back to DHB of
domicile
Data flow
DHBs & private
providers
Date of first treatment
New data capture or flag for treatments: targeted therapy, non-intervention
management
Data capture
All DHBs
Low
New field to capture where external DHB has provided treatment
Data capture
All DHBs
Medium
New fields to capture reasons for delays for each indicator, where applicable
Data capture
Business process required to report these to DHB of domicile in timely fashion
Data flow
DHB of service for first
treatment
Delay code
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 12 of 44
DHBs & private
providers
DHBs & private
providers
Medium
High
Medium
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
5.4.2 High level summary of proposed DHB changes 2012-13
Each DHB has identified the system changes required to enable FCT data collection. Detailed
information regarding these changes is in Appendix D: DHB and regional approaches/data flows.
Bay of Plenty
A comprehensive plan has been developed in consultation with clinicians, to make changes in DHB
systems to collect data elements with exception of reason for delays for each indicator. It is expected
that this will be addressed as work proceeds.
Lakes
Some data elements will be collected in iPM. There is no plan to make changes to iPM in 2012-13
other than add a high suspicion of cancer flag. The reason for this is that the scope of a planned
upgrade to iPM has been signed off and no further changes can be implemented until this is
completed. A cancer nurse tracker will be required to coordinate manual data collection.
Tairawhiti
A FCT register has been developed in iPM which will require a cancer nurse tracker to enter all data.
All the key data elements are able to be collected but it does not record external referrals to treating
DHBs. Manual data entry has commenced.
Waikato
A high level requirements document has been completed by Waikato IS outlining changes required to
extract data from standalone databases and the PMS into a staging database. Provision has been
made for the manual data entry of delay reasons. Development of this solution has been scheduled
for November 2012.
Midland
Waikato DHB will develop and host a regional FCT database where Bay of Plenty, Lakes, Tairawhiti
and Waikato DHB extracts can be consolidated and relevant information reported back to DHB of
domicile. Data extracts from non-Midland DHBs will also be incorporated in the consolidation
process. The Midland Cancer Network Business Analyst will be responsible for data consolidation
and reporting.
5.4.3 People
Regional FCT Project Manager
A Regional FCT Project Manager (0.5 FTE) located at the Midland Cancer Network will be recruited to
work across all Midland DHBs.
The Regional FCT Project Manager will:
• have oversight of any cancer nurse trackers appointed and the collection of data for the
indicators as a whole
• provide regional leadership for the FCT implementation
• project manage and coordinate FCT system development
• provide regional expertise on FCT indicator definition and inclusion
• participate in national FCT forums
• become familiar with all regional and national initiatives that impact on the FCT initiative
• understand the alignment of the FCT indicators, cancer care coordination and tumour stream
standards development
• progress the development and implementation of systems and processes that advance this
alignment
• identify initiatives that will facilitate the FCT process and engage with the initiatives project
managers and project sponsors to enable this
• provide leadership on any regional system procurement
• participate in any national system procurement
• be responsible for developing a 2013-14 regional FCT plan to transition the reporting
requirements into DHB business as usual practices.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 13 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Regional business analyst
It is recommended that a regional business analyst (0.5 FTE) be recruited. This role will be located at
the Midland Cancer Network.
The regional business analyst will
• provide regional consolidation of FCT data
• run regular data quality audits in the regional FCT database
• identify data quality issues
• provide regional level reporting of FCT data
• assist FCT cancer nurse trackers with compilation of DHB data extracts
• develop FCT inter-DHB reports for any DHB in the country
• provide guidance to DHB FCT cancer nurse trackers on FCT data definitions and FCT
episode inclusions and exclusions
• participate in national forums
• in the absence of a national FCT data collection protocol will develop a regional FCT data
collection protocol
• progress linkages between the regional FCT database and any MDM databases.
DHB FCT cancer nurse tracker
Each DHB is responsible for gathering the data required to inform the indicators for each patient who
has a high suspicion of cancer in the DHB. DHB FCT cancer nurse trackers are required at each
DHB to support critical data collection especially across referral coordination, surgical and medical
services.
The DHB FCT cancer nurse trackers will:
• be employed within local DHB services with a clear accountability for delivering improved
cancer care for the population
• liaise with MDM coordinators and cancer nurse coordinators (where established)
• work together regionally, together with local DHB health information systems experts, to
ensure the required data is captured including reasons for delays
• work in close collaboration with other DHB FCT cancer trackers. This will be particularly
important where patients receive diagnostic tests or treatment for cancer at a different DHB
than their domicile DHB
• be given (electronic) access to all patient information relating to resident populations across
all DHB information systems
• be responsible for ensuring that data is reliable and complete, and that all required extracts
and reports are generated, checked and submitted.
6 Action Plan
6.1
FCT indicator reporting
Activities
When
Who Leads
Milestones
Business analyst position established
DHBs appoint cancer nurse trackers
July
Oct-Dec
MCN manager
DHBs
Appointed
Positions filled
DHBs implement IS changes in each
DHB (Appendix D: DHB and regional
approaches/data flows)
Agree a regional data set which includes
business rules, roles and responsibilities
and timeframes
Work with DHBs and PHOs to
understand implementation of eReferrals
in both primary care and between
specialists to ensure all eReferrals with
high suspicion of cancer are captured
By Dec
DHBs
IS changes
completed as per
DHB plan
Data set agreed
Oct-Dec
Oct
2012-10-15_ FCT Regional Implementation Plan Final.doc
FCT Project
Manager and
Business Analyst
FCT Project
Manager
All eReferrals
include HSC flag
Page 14 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Activities
When
Who Leads
Milestones
Processes to
capture all
internal referrals
for HSC
developed
GPs and SMOs
aware of HSC
flag and
importance to
FCT data
collection
Regional FCT
database in
place
Work with DHBs to understand internal
referral processes to ensure those with a
high suspicion of cancer are captured
Oct
FCT Project
Manager and
Business Analyst
Provision of education to referrers
regarding the high suspicion of cancer
flag
By Dec
FCT Project
Manager and
Business Analyst
Work with Waikato IS to develop and
implement a regional FCT database
Sep-Dec
2012
High level mapping of current tumour
stream pathways in each DHB so as to
understand associated business
processes and utilise in linking patient
pathways
Investigate MDM agenda data capture in
PMS in each DHB to assist in linking
patient pathways
Work with Tairawhiti and CCN to
determine the approach for TDH
reporting for 2012/13 (service changes
do not come into place until 2013/14)
Work with non-Midland DHBs on
processes for transfer of data re Midland
DHB domiciled patients and for transfer
of information re their patients
Planning and Funding and provider arms
to work with publicly funded private
providers to enable reporting of required
data for FCT indicators - including
palliative care providers.
Investigate laboratory notification
process for flagging cancer diagnosis
Oct-Nov
FCT project
manager, data
analyst/Regional
IS
FCT Project
Manager and
Business Analyst
Investigate regular and frequent
notification of all positive cancer results
from laboratories across the region into
regional FCT database.
“Dry runs” of data matching working
retrospectively from monthly
chemotherapy and radiotherapy
treatment data
Quarterly review of action plan – update
as required
Oct-Dec
FCT Project
Manager
Oct-Dec
CCN/MCN/TDH
Oct-Dec
NCN/Midland
Cancer
Network/CCN
2012-13
DHB P&F and
provider arm
outsourcing
2012-13
Business Analyst
2012-13
Regional IS and
Business Analyst
Oct-Dec
Business Analyst
Jan/April
FCT Project
Manager and
Business Analyst
2012-10-15_ FCT Regional Implementation Plan Final.doc
Current tumour
stream pathways
mapped
MDM data
capture in PMS
in each DHB
Agreed
processes for
2012-13
developed
Agreed
processes for
2012-13
developed
Mechanisms for
provision of FCT
data included in
contracts
Options
identified where
feasible
Options
identified where
feasible
Learning to
inform system
development and
design
Review
completed
Page 15 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
6.2
Wider FCT programme
Activities
Who Leads
Milestones
Establish a regional FCT Project
Manager role to lead, coordinate and
facilitate the FCT programme of work
(subject to funding)
Establish Regional FCT Steering Group
Jul/Aug
2012
MCN Network
Manager
Appointed
Jul 2012
Midland FCT Work Group established
Jul 2012
MCN Network
Manager
MCN manager
Establish FCT Implementation Groups in
each DHB
Identify DHB FCT leads
Jul 2012
DHBs
Jul 2012
MCN manager
Cancer MDM Action Plan implemented to
improve access to timely MDM decisionmaking
2012-13
MCN MDM
Project Manager
Implement care coordination roles
Oct-Dec
2012
Feb 2013
MCN/All DHBs
Group
established
Group
established
Groups
established
Leads identified
in each DHB
Increased
number of
patients
discussed at
MDMs
New roles in
place
Plan completed
RSP/DHB APs
informed
Develop Phase 2 plan identifying actions
for 2013/14 and feed into RSP and DHB
AP planning processes
6.3
When
MCN FCT Project
Manager
Investment approach and cost
Some funding was initially allocated by the Ministry of Health with a DHB contribution through the
Midland Information Services Executive. An additional review of this plan in September by the
Ministry of Health resulted in additional funding being made available.
Summary of funding for Midland FCT Implementation Plan
Source
To be used for
Funding
Ministry of Health
Midland DHBs’ contribution through
Regional IS prioritisation. Does not
include contribution of DHB staff as part
of business as usual
Ministry of Health
Total
IS and non-IS allocation
IS
$215,000
$50,000
Non-IS allocation
$145,000
$410,000
Allocation of funding for Midland FCT Implementation Plan
Organisation
To be used for
Responsibility
Funding (up to)
Midland Cancer
Network
Regional FCT
database
Regional IS/Waikato IS
$45,000
Waikato DHB
HSC flag implemented;
new
data
extract
routines;
staging
database and DHB
FCT database
Waikato IS
$41,000
Lakes DHB
No changes planned to
iPM but funding
required for data
matching
Lakes
$32,000
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 16 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Organisation
To be used for
Responsibility
Funding (up to)
Bay of Plenty DHB
Development and
implementation of
changes to WebPAS
Business
Unit
Intelligence
$65,000
Tairawhiti DHB
FCT Register built
within iPM with manual
data entry
CIO
$20,000
Midland Cancer
Network
Regional project
manager and
Analyst
Midland Cancer
Network
$60,000
Waikato DHB
Cancer nurse tracker
COO
$63,000
Bay of Plenty DHB
Cancer nurse tracker
COO
$42,000
Lakes DHB
Cancer nurse tracker
COO
$28,000
Tairawhiti DHB
Cancer nurse tracker
COO
$14,000
Total
6.4
$410,000
Risk management
The following table outlines the most significant risks for the implementation of this plan.
Risk
Probability
H/M/L
Impact
H/M/L
Inadequate funding to support
implementation
H
H
FCT implementation plan
Inadequate resource to
support implementation
H
H
IS change will be slower
Lack of consistency in
understanding data definitions
leading to DHBs using
different proxies for data
elements
M
H
FCT project manager and
business analyst provide clear
communication; engaged
nationally
Lack of clinical leadership and
buy in. People thinking it is
someone else’s responsibility
to capture/record data
M
H
Communication Plan
Recruit to clinical leadership
vacancies
DHB lead clinician to lead local
engagement strategies
Data in standalone databases
if extracts not easily provided
to data repository
M
H
FCT project manager works
with owners to ensure agreed
dataset can be regularly
extracted
CT/MRI access does not
allow DHBs to meet FCT
H
H
Monitor impact
Communication about the
M
M
Communication plan – agreed
2012-10-15_ FCT Regional Implementation Plan Final.doc
Mitigation strategy
Page 17 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Risk
Probability
H/M/L
Impact
H/M/L
FCT programme raises
stakeholder and public
expectations
Mitigation strategy
key messages
Not able to identify patients
with cancer diagnosis
M
M
Work with laboratories and IS
to investigate frequent
notification of positive cancer
results
Not being able to meet
timeframes for mandatory
reporting
H
H
FCT project manager and
business analyst work closely
with DHB FCT teams
DHB FTE capping does not
permit implementation of new
positions
M
H
Communication processes in
place with DHB management
National Working Groups not
linking with clinical
governance and regional
MDMs
H
M
Ensure communication
processes through RCNs with
clinical leads to local clinicians
Resisting change and
dissenting views on what
constitutes best clinical data
capture points
M
H
FCT project manager and
business analyst work closely
with DHB FCT teams
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 18 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Appendix A: Midland Cancer Network regional initiatives
Regional service plans
The Midland FCT work programme is referenced in the following regional service plans:
•
Regional Clinical Services Plan 2012-13
•
Midland Regional Information Services Plan
•
Midland DHB Annual Plans 2012-13
•
HealthShare Ltd Statement of Intent and Business Plan 2012-13
•
Midland Cancer Network Annual Plan 2012-13.
Significant regional cancer initiatives
The Midland Cancer Network has a significant work programme for 2012-13 and all aspects of this
work programme are linked to the FCT indicators. The region’s cancer control work programme is
driven from national priorities, lead network for national work, strategic regional initiatives, business as
usual and areas of focus for regional/local service improvements. Understanding of these initiatives
and the links is critical to the success of implementing the FCT indicator plan for the region.
Improving regional lung and bowel cancer
Midland Cancer Network has had some experience in reporting wait times for Midland lung and bowel
cancer patients. Experience has been that this is complex and resource intensive with significant
assistance required to support clinicians to help them understand what the data is showing.
Cancer multidisciplinary meeting development
Developing cancer multidisciplinary meetings (MDMs) has been a clinician priority. DHBs have
provided little investment over the years and only this year has the sector realised their value to
patient outcomes. Cancer MDMs, where recommendations about patient’s treatment options are
made, can be a rich source of information; this data is not utilised to its full potential.
The network has invested one-off funding to upgrade the audiovisual equipment in the radiology
conference rooms where many MDMs are held at Waikato, Tauranga and Rotorua Hospitals. This is
in preparation for HD video conferencing across the region. Midland IS has prioritised funding for
videoconferencing endpoints in 2012-13; the details of the implementation are yet to be confirmed.
The Ministry of Health announced DHBs were to reinvest savings for cancer MDM development from
1 July 2013. The Midland GMs Planning and Funding are collaborating with the network in the
prioritisation of this funding.
The network has completed a high level stocktake of regional and local cancer MDMs and submitted
this to the Ministry of Health. A detailed gap analysis against the recently published national guidance
document for best practice MDMs is under way. MDM coordinators will be required to support future
development. A Midland Cancer MDM Gap analysis and Action Plan 2012-2014 has been endorsed
by the Midland GMs planning and funding.
The network is developing standalone clinical databases to collect minimum datasets for tumour
specific MDMs. At some stage in the future this data needs to be integrated. Other priorities include
development of electronic MDM referrals/proformas.
Tairawhiti adult cancer services transition to Waikato
In April 2012 Tairawhiti DHB announced its decision to transfer its adult cancer services from
MidCentral to Waikato effective 1 July 2013. Planning for this significant service change has
commenced.
There are FCT implications when most Tairawhiti services will continue to flow to Central region for
2012-13, for both reporting and when trying to plan and drive service improvements to patient care.
Tairawhiti joins Midland Cancer Network
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 19 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
As part of the service change Tairawhiti transfers from Central Cancer Network to Midland Cancer
Network effective 1 July 2012. This transition has commenced with the development of this
implementation plan.
Midland radiation oncology
Reporting for the radiotherapy and chemotherapy health targets links with the FCT indicators. Bay of
Plenty DHB has signalled the entry of a private provider in Tauranga. The region has undertaken a
demand and capacity modelling initiative in partnership with radiation oncology experts, Ministry of
Health and the private provider. This report informs the number of linacs required for the region out to
2026 for the regional radiation oncology service plan.
Midland medical oncology
Midland put the service planning for medical oncology on hold awaiting the outcome of the Cranleigh
Report and the subsequent national medical oncology implementation plan. The Cranleigh Report
highlighted that services in New Zealand were vulnerable and there were risks that there would be
inadequate resource to service the demand. A regional plan is critical to ensure that the right people,
processes and systems are in place to support achievement of the health target and FCT indicators.
Midland palliative care
Midland has started to plan palliative care service for each DHB with the aim to have an overarching
regional plan where it makes sense to work collectively on common priorities. DHBs fund a significant
proportion of hospices to provide services for local populations. The Midland hospices are in the
process of implementing PalCare information system. There is no mechanism to link this to DHBs.
There is inadequate palliative care specialist resource to attend every cancer MDM within the region.
There is no agreed common dataset that hospices report that links to FCT indicators. This needs
some consideration.
Tentatively there are planned service changes in Tairawhiti who have undertaken a local palliative
care service review.
Bay of Plenty has commenced developing a district-wide hospital palliative care service. This will
support the entry of a private radiation oncology service.
National lung and breast cancer work programmes
Midland Cancer Network has a Ministry of Health 2012-13 contract agreement for the ongoing
functioning of the National Lung Cancer Working Group. This group is developing a national
minimum dataset. There needs to be consideration of how this dataset along with other major tumour
stream datasets can be integrated into FCT data collection.
The network has a Ministry of Health contract agreement until 30 June 2013 to facilitate the National
Breast Cancer Working Group programme to develop national breast cancer standards, patient
pathway and service delivery framework that supports the standards.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 20 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Appendix
funding
B:
Regional
information
systems
Briefing Note to Midland IS Executive- FCT Indicators
Jan Smith has requested that the IS Executive release the allocated FY12/13 funding for
implementing the FCT Indicators. An implementation plan has been submitted to the Ministry of
Health and a funding contribution allocated within it for IS development. The funding will be managed
by the Midland Cancer Network.
Responsibility for the IS changes (DHB and Regional) will sit with the Regional CIS Programme.
Implementation will be done by each DHB IS function with regional database development will be
done by Waikato DHB IS.
For simplicity, it is proposed that as each DHB will incur costs in excess of their PBF share of the IS
Portfolio $50k, that this is taken into account and deducted from the funding provided from Midland
Cancer Network on completion of the required IS development.
Operational IS costs for DHB components will need to be budgeted by DHB CIOs, with operational IS
costs for the regional components budgeted by Waikato DHB, with the expectation that this will
transfer to HealthShare as soon as is practicable.
Recommendation: It is recommended that the IS Executive approve Midland Cancer Network and
the CIS Programme proceeding to secure necessary DHB approvals and implement the FCT
Indicator reporting.
Midland IS Executive Minutes - Faster Cancer Treatment Indicators
• The papers from Jan Smith were noted.
• The approach to management of the delivery and budget were supported.
Decision: IS Executive approve Midland Cancer Network and the CIS Programme proceeding to
secure necessary DHB approvals and implement the FCT Indicator reporting.
Draw down process
1. Responsibility for the FCT Implementation plan sits with the Midland Cancer Network. The IS work
is one component of this plan.
2. Responsibility for the IS changes (DHB and Regional) sits with the Regional CIS Programme.
Implementation will be done by each DHB IS function; regional database development will be done by
Waikato DHB IS.
3. The full IS cost estimate of $203k will be shown in the portfolio, noting that $153k is MOH funded.
Regional CIS programme (HealthShare) will hold this funding.
4. MOH funding is for 'external/additional" project costs not internal staff costs unless these are able
to be capitalised. I will validate DHB IS implementation costs to check for this.
5. Operational IS costs for DHB components will be budgeted by DHB CIOs.
6. Operational IS costs for the regional components will be budgeted by Waikato DHB, with the
expectation that this will transfer to Healthshare as soon as is practicable.
Can you please break down your submitted costs under the following headings for tracking purposes:
SERVICES
HARDWARE
SOFTWARE
MISCELLANEOUS
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 21 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
OPEX
CONTINGENCY
Draw down of funds from the CIS programme will be approved by the Board on submission of a
request along with supporting documentation such as invoices. Funding will be delivered to the MCN
from the MoH via the lead DHB (Waikato) in tranches yet to be decided and any draw downs will have
to align with these payments.
As per the Midland IS Executive (notes below) you are asked to draw down on your portion of the
$50K in the regional IS capital plan for this purpose before drawing on the MCN funds supplied by the
MoH.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 22 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Appendix C: DHB information systems – current
and future state
Current state
Currently there are two key sets of issues affecting Midland DHBs, and inhibiting their ability to report
on these indicators:
• Data capture – certain required data elements are not captured at all,
• Data flows – internal and external patient flows mean that the linking of events and timely
reporting back to DHBs of domicile must be embedded in local business processes to a far
greater extent than happens currently.
Data capture issues
Prior to any system changes arising from FCT, the key issues around capturing required data
elements can be summarised thus:
•
•
•
•
•
•
•
•
•
no single patient episode ID is available that remains meaningful across all treatment
pathways and service providers
date of initial referral from primary to secondary care is not visible to DHB of service if this is
different to DHB of domicile
there remain differences in interpretation of some data elements
identifying referrals with ‘high suspicion of cancer’ does not currently occur
data elements on treatments other than radiotherapy, chemotherapy or surgery are not
routinely captured
2
date of decision to treat for radiotherapy, chemotherapy or surgery is only available by proxy
diagnostic (ICD10) data is only generally available for inpatients within DHB systems
MDM data is not consistently recorded in systems that are easily accessible
Facilities to record delay reasons after each FCT interval do not currently exist.
Lakes DHB has advised that the scope of a planned upgrade to their PMS has been signed off. They
will move to a new clinical workstation in the near future. Therefore they will not make any changes to
the PMS in 2012-13.
Data flow issues
The need to improve data flows across the region implies that proportionally greater work needs to be
undertaken at Waikato. Current health target reporting at Waikato occurs across a range of
organisationally unsupported information systems, and there is minimal resource capacity to meet the
extended scope of FCT reporting. The key issues around data flows should be broken down by
source and destination to gain a comprehensive understanding.
Inter-DHB
• DHBs of service do not have visibility of the initial urgent referral details from primary care (or
via other referral pathways), where DHB of domicile is different.
• DHBs of domicile do not have visibility of decision to treat, treatment details and delay
reasons where DHB of service is different.
• Some Midland DHBs will require data from Northern and Central region DHBs for their
patients depending on particular treatment pathways.
Intra-DHB
• DHBs do not always have visibility of patients being treated by publicly funded private
3
providers .
• Linking of internal DHB services, such as oncology and surgery, is patchy.
2
Booking request date or date of certainty on surgical wait list
For example, urology patients in Bay of Plenty and Lakes, breast patients in Lakes and most palliative care
treatments across the region.
3
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 23 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Summary
Because data flows are so important, all DHBs in the region are to a greater or lesser extent reliant on
Waikato as the tertiary treatment centre. If Waikato is not able to meet all of these requirements, then
this will negatively impact on each DHB’s ability to report on the FCT indicators – irrespective of how
advanced local arrangements might be. Adopting this kind of ‘lowest common denominator’
approach, regional ability to meet the requirements can be summarised thus:
Data Element
Meets regional
requirements?
Notes
Ethnicity
Yes
DHB of domicile
Yes
DHB of receipt of
referral
Captured at DHB of domicile; not visible to DHB of
service if different.
No
Date of receipt of
referral
Captured at DHB of domicile; not visible to DHB of
service if different.
No
High suspicion of
cancer flag
Not available.
No
Date of FSA
Primary site ICD
Date of decision to
treat
Type of first treatment
Date of first treatment
Difficulties around data flows from private
providers (e.g. Urology).
Only recorded for inpatients having surgery or
radiotherapy.
This data is generally recorded at DHB of service
but not visible to DHB of domicile. Differences in
interpretation require clear and consistent business
rules.
Generally recorded at DHB of service, but not
visible to DHB of domicile. In all cases, difficult to
obtain data on treatments other than surgery,
chemotherapy or radiotherapy.
Generally recorded at DHB of service, but not
visible to DHB of domicile. In all cases, difficult to
obtain data on treatments other than surgery,
chemotherapy or radiotherapy.
Yes
No
No
No
No
DHB of service for first
treatment
Not recorded in all cases.
No
Delay reason code
Not recorded, and would not currently be visible to
DHB of domicile if patient being treated elsewhere.
No
NHI
Yes
Age
Episode ID
Yes
Unique numbers can be generated currently, but
become useless if other service providers are
involved. Only feasible if regional database is
created and used.
No
Source of referral
Yes
Urgency of referral
Date patient informed
of diagnosis
Date of most valid
diagnosis
Yes
Date of MDM
No
Can be obtained for inpatients only.
No
MDM data not stored consistently, or accessible in
all cases.
No
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 24 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Projected future state
Midland has agreed:
• Local DHB solutions to capture and collate FCT indicator data elements utilising technology,
people and/or processes
• Regional FCT database for:
o Midland Cancer Network DHBs to submit data
o DHBs outside of the Midland region to submit data
o Regional report back to other DHBs outside of Midland for those patients treated
within Midland
• Build regional expertise for:
o report consolidation back to Midland DHBs and relevant narrative
o quality assurance, audit and control of data
o standardised reporting and monitoring
o supporting regional clinical audit and reporting back on specific areas of focus for
service improvement
o linking to other regional cancer networks and DHBs
o linking with National Cancer Team.
• Resources are required at local and regional level to support technology changes to DHB
information systems and people to collect and collate data not captured in DHB information
systems.
The proposed ‘future state’ takes as its assumptions the following regional agreement:
• DHBs retain responsibility for local system changes and process change management
• comprehensive reporting is only achievable at a regional level
• Midland Cancer Network will be responsible for a regional FCT database which receives data
extracts from DHBs and consolidates them into the agreed reporting template.
Clearly this is a change to current practice, and requires free flows of information between DHBs and
a regional FCT database. The need for a regional FCT database arises from the following:
•
many Midland patients are treated outside of their DHB of domicile
•
the FCT indicators place the reporting obligation on the DHB of domicile
•
in many cases, data flows between DHB of service and DHB of domicile are poor.
Only a regional FCT database has the capacity, dependent on free flow of information into and out of
it, to connect the different service points along each patient pathway and to enable reporting. At the
same time, it is not intended that this replace DHB data or assume ownership of it in any way; DHBs
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 25 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
remain responsible for making local system changes and submitting an accurate data extract to the
FCT database.
The region has agreed on a phased approach, whereby only patients receiving certain treatments will
be included in the short-term with a phased roll-out across other pathways.
Phase 1: Patients having surgery, radiation therapy or chemotherapy.
Phase 2: Patients having other treatments (2013-14).
Required business process changes – regional perspective
Business process change 1: High suspicion of cancer notifications to domicile DHB
Actual implementation of the ‘high suspicion of cancer’ flag in local PMS is less problematic than the
change in business processes it requires. Midland DHBs have agreed this can be flagged on referral,
and then either confirmed or withdrawn by an SMO at grading. It is expected that DHB referral
coordination centres will carry this out, pending implementation of local business processes that
require they be notified of any change in status.
This will also need to be visible to the regional FCT database so those patient details can be removed
from the FCT cohort, otherwise data extracts should only be sent after triage when this flag is
effectively ‘confirmed’.
Issues
• Agreement from DHB referral coordination centres to use new data field in the PMS.
• Education with these teams about use of new data field.
• Clarify how this can be communicated to triaging clinician.
• Education with triaging clinicians about use of new data field, and ‘overriding’ the flag from a
referrer.
• Clarify how an ‘override’ is communicated back to referral coordination centres if triaging
clinicians are not updating PMS themselves.
Business process change 2: High suspicion of cancer notifications to regional FCT database
Midland DHBs will send extracts of all patients with this flag to the regional FCT database, in
accordance with the prospective reporting method agreed upon. Agreement on data transfer
protocols, privacy and confidentiality has yet to be determined.
Timing of this notification can occur in two ways:
• all such referrals are sent to the FCT database. Separate notification is then sent if the
flag is removed and these patients will be removed from the data set
• only patients who still have this flag active after triage will be sent to the FCT database.
Issues
• Need to clarify privacy issues, and set up safe transmission of data (SSH/rsync).
• Need to identify appropriate frequency of data transmission (e.g. weekly).
• All DHBs must be able to identify patients with this ‘flag’.
Business process change 3: Confirmed diagnosis of cancer
The Ministry of Health has indicated this should preferably be obtained from pathology. Mechanisms
to obtain this information quickly and easily should be implemented – however timely access to the
MOH Datamart is not currently an option.
Issues
• Diagnosis data is generally available only for inpatients, and often with a time lag.
• MDM data could be used for diagnosis if it can be gathered and accessed easily; in any
case, the MDM process should not be affected simply because of data-gathering
requirements for FCT.
• Where investigations confirm that no cancer is present (or there is a cancer present, but
one noted in the exclusions list of the MoH Data Definitions guide) this must be notified to
the regional database to ensure the patient is removed from the FCT cohort.
Business process change 4: Decision to treat date
DHBs have indicated initially that this will be derived from treatment booking request data for Phase 1
implementation of surgery data. This is currently captured for most chemotherapy and radiotherapy
first treatments. Derivation of this field for other treatment types has not yet been determined.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 26 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Business process change 5: First treatment
Regional data set will collate treatment details (for surgery, chemotherapy and radiotherapy only in
phase 1) and match with existing data. Data collection for other treatment types will be addressed
subsequently.
Issues
• Treatment date is available electronically in current systems for surgery, radiotherapy and
chemotherapy.
• Care must be taken to ensure that only surgical ‘treatments’ (rather than investigative
procedures) are counted as first treatments – this will require a definitive list of surgical
procedure codes.
Business process change 6: Delay codes
Provision for entry of delay codes has been made at Waikato (via an app built on top of the Waikato
staging database) and Tairawhiti. This data will form part of the regular extract to the regional
database. As noted above, this is less problematic than the local business processes around exactly
who does this and at which stage. (Decisions will need to be made by clinical staff and may involve
reference to patient letters and/or medical file. Clinical engagement work required).
Issues
• This is a manual step which will require manual intervention and data entry
• People will need to be allocated to take primary responsibility for this, depending on
which area they work in
• Some reporting feedback mechanisms will need to be built to enable identification of
those patients requiring a delay reason code
• Given the requirement for quarterly reporting, it is likely that weekly feedback of patients
exceeding FCT intervals will be required to enable the delay reasons to be found and
entered in time
• DHB of service MUST have access to the date of initial referral, if it is to be able to
identify when indicator 1 has been exceeded and must identify a reason
4
• Access to relevant data from private providers has still not been established .
Business process change 7: Data extracts from non-Midland DHBs.
Because some regional patients are treated outside of Midland DHBs, there is a need to obtain
treatment data from other DHBs for inclusion in the regional FCT database. Protocols with specific
DHBs need to be established to ensure this process is electronic wherever possible, and based on
DHB of domicile field data held in their own systems. It is recommended that there is national
consistency for this business process change.
Issues
• Identify which non-Midland DHBs might be involved in treating Midland’s patients
(Tairawhiti have planned to follow-up details about their patients by phone, so this
information will be in their local register).
• Need to establish data-sharing protocols with those DHBs.
• Consider asking other regional databases (where they exist) to extract any data for
patients domiciled in a Midland DHB routinely, and forward for inclusion in the Midland
regional database.
• Need to clarify privacy issues, and safe transmission of data.
4
Although urology data is available at Waikato
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 27 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Appendix D: DHB and regional approaches/data
flows
Lakes
Background
Lakes DHB Clinical Services along with other Midland DHBs are required to report on the Faster
Cancer Treatment Indicators as described in the Ministry of Health 2012/13 DHB non-financial
monitoring framework and performance measures. DHBs are required to start reporting on these in
the first quarter.
Problem definition/issues
Lakes DHB patient management systems (PMS) will not contain all the information of the indicators
for much of the patient’s care, including the key trigger points; this may occur at other DHBs or
providers. It will therefore be difficult to track the patient’s journey from the Lakes DHB PMS through
all the stages and meet the reporting requirements.
When the activities occur at a Lakes DHB hospital and is recorded in the local PMS the data is able to
be extracted. However some of the information required will not be entered into the electronic record
and may be noted in the clinical file. Other information will be held in another providers system.
It will also be difficult to identify the patients that are required to be included in the reports until a
diagnosis is made and this may be not be until histology reports are received. Lakes clinicians may
receive a referral with a number of symptoms, carry out diagnostic investigations, then refer on to a
tertiary provider with a high suspicion of cancer. At this stage we don’t record outgoing referrals.
Therefore a lot of the mapping to the indicators will need to be retrospective when a decision to treat
has been made.
As Lakes is planning to move to a new clinical workstation within the next two years and will be
implementing an upgrade to i.PM and other systems later this year we do not plan to introduce any
other changes into our PMS systems at this time.
Risks:
The risks are that the report will be incomplete and won’t be timely.
Estimated costs
It is difficult to identify any exact support required to meet the information system improvement to be
able to report these indicators, especially without any defined specifications.
Estimates as follows
• PMS system changes
None expected at this stage; if changes are required to the clinical workstation these will need
to be part of a formal scoping exercise outside of this project.
Future work is planned to record outgoing referrals but no scoping has been carried out for
this so the costs are unknown.
Estimated - $15,000
• Clinical Data Repository
The success of the project is dependent on a regional clinical data repository and we would
support this work as a priority.
• Data extract
Expected costs to develop the data extract from the Lakes DHB systems where components
of the patient’s care occur at Lakes DHB hospitals. These would include related referrals,
FSAs and surgical procedure or commencement of chemotherapy.
Estimated costs are - $17,000
• Data match
Expected costs to match the data from other DHB systems included in the above costs
• Change management and reporting coordination
We estimate 0.25 FTE of a senior nurse is required to lead any clinical process change
required to meet the indicators and to coordinate the patient information flow across DHB,
check clinical files etc
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 28 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
This would fit with the cancer care coordinator roles especially as these nurses will also be
key in identifying any delays in the pathways for individual patients as well as areas for
improvement.
Estimated costs are - $27,000
Summary
Lakes DHB Clinical Services support the priority of a regional clinical data repository to better enable
the reporting of the FCT indicators.
Estimated additional costs to Lakes DHB are
• System changes improvements:
• Data extract and match from Lakes systems:
• Change management and reporting coordination :
• Total
$15,000
$17,000
$27,000
$59,000
Tairawhiti
Faster Cancer Treatment Indicators Register
Background
The Minister of Health has issued reporting requirements in respect of cancer treatment.
The ability to meet the reporting requirements is dependent upon identifying referrals where there
exists a “high suspicion of cancer”.
Referrals from general practitioners to TDH are currently made electronically via the BPAC electronic
referrals system.
A “flag” has been added to the referrals such that the GPs can identify where there is a “high
suspicion of cancer”, and a “cancer register” which provides for the relevant data to be entered so that
the cancer treatment reporting requirements can be met, has been built into the iPM patient
management system.
It is therefore proposed that at least for all GP referrals the processes detailed below be instigated to
meet the cancer treatment reporting requirements.
Accessing the BPAC referrals to identify the cases of “high suspicion of cancer”
Referrals will be received as usual via BPAC from general practitioners, printed, entered into iPM by
the Referrals Clerk and forwarded to the appropriate specialties as per usual.
In addition to the normal referral management process, the Cancer Register Co-coordinator(s) will log
into BPAC and download the referrals flagged as “high suspicion of cancer”. The process to do this is
detailed below.
To identify referrals flagged for high suspicion of cancer
Log onto BPAC
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 29 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Double click
to open extended search screen
Enter the dates you want to select referrals to and from.
Remember to tick the “Include filed referrals” box to select all referrals.
This will result in a list of all referrals received between the selected dates.
Select the “Sort by” drop down box and select “Urgency”. This will sort the referrals based on the
urgency assigned by the GP and group all the high suspicion of cancer referrals together, they will be
flagged with the colour XXXX
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 30 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Scroll down to locate the referrals you require.
Select the referrals required, using the tick box to the left of screen and click print.
This will print the flagged referrals so they can be entered into the iPM High Risk Cancer Register.
iPM High Risk Cancer Register.
This register has been created to group patients with referrals flagged with a high suspicion of cancer
and capture the information about the patient’s journey from referral to first treatment as required by
the Ministry of Health.
To create a register entry in iPM.
Log into iPM
Select Patient Registers by clicking the icon
Select the Cancer Register and click “Find Now”
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 31 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
This will produce a list of all patients currently on the register.
To add a patient
Right Mouse Click (RMC)
Select “New Register Entry”
Enter the patient’s NHI from the referral and click “Find Now”
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 32 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Select the patient and click “OK”
“New Register Entry” screen
Enter the “Entry Date” This will automatically populate today’s date.
Select “Cancer Register” as the Register from the drop down box.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 33 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
This will enable the “Faster Cancer Treatment Indicators” tab.
This tab is used to capture all the information needed for reporting.
Click on this tab to open it.
Enter the date the referral was received
Select the Receiving DHB
Select the patient’s Domicile DHB
Click “OK”
The patient will be placed on the Register.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 34 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Update a register entry
Select Register using the Register Icon
and choose the Cancer Register
Double click on the patient you wish to
update.
Select the “Faster Cancer Treatment Indicators” Tab
As the patient is seen and reaches each of the Key Indicator points enter the data required using the
date fields and drop down selection boxes.
Bay of Plenty
Information Services estimate of new requirements to enable data collection and reporting for Faster
Cancer Treatment process and indicators.
Background
BOP DHB is involved in collaborative discussions with the other DHBs in the Midland region and with
Midland Cancer Network (MCN) to determine the data collection and reporting requirements for
implementation of the FCT information requirements.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 35 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
We acknowledge that this will be a phased process over at least 12 months, however we have
identified key information systems that will require change, and have worked with MCN to ascertain a
"minimum dataset" for this collection. Detail is provided in the templates already submitted, and this
is an overview of applications to be implemented or developed in the initial stages.
Estimated cost: (See detail below)
Type of IS Resource
Development Management, Systems Analysis, Data
Governance, and Database design and architecture
Web developer and senior programmer/analyst for
interfacing direct to PMS
Clinical applications specialist support - PMS and
Healthviews configuration changes, codes setup, user
security roles set up for each MDM
MS Reporting Services and SQL report writing
Days
40
Rate per
day
600
Estimated
initial cost
$24,000
67
400
$26,800
18
345
$6,210
20
400
$8,000
Bay of Plenty DHB – Estimate of changes and costs for implementation of Faster Cancer Treatment
information requirements
Phase 1 Tactical
Application
Estimated time
Strategic
Regional impacts
for immediate
changes and
and cost
solution
FCT
development
requirements
required
Enable collection
WebPAS screen
2 days design,
May move to eRegional
of high suspicion
changes all
agree and meet
Referral in
implementation of
of cancer flag,
Departments.
2 days IS clinical Concerto so that
Concerto Clinical
diagnosis date in
Change
applications PMS GP assigns the
Intranet and
existing referrals
management
development
suspicion of
eReferrals.
application.
process –
cancer flag
Requires regional
clinicians to
Becomes part of
steering group
SMO grading
assign the flag
agreement
process
Concerto CI has a
Provide Clinical
Enable existing
WebPAS screen
2 days PMS
Intranet accessed
forms toolkit
referrals to record changes.
configuration to
module that will
include new
specialty specific
diagnosis and
web forms to
allow the
date, also first
Manual clerical
fields all
SMOs so that
developed MDMs
treatment type
process to search departments.
to be ported to the
the info until there New codes setup diagnosis and
are clinician web
and
MDM information
new application
forms developed.
implemented.
can be recorded
without entire
rework.
by clinicians
Requires dataset
Change
during the
management
diagnostic process and MDM
process to collect to support their
proforma template
clinical patient
agreement
the data.
information
requirements
Enable CI
Develop generic
2 day design and Phase this form
As above.
collected data to
front end web
set up db
out as the MDM
Requires dataset
be written back to accessed form for 3 days
forms are agreed
and MDM
WebPAS
all departments
development for
and developed
proforma template
automatically for
and SMOs to
negotiating with
with specific
agreement across
the Diagnosis and record both the
vendor and
information
specialties.
date
diagnosis date
writing to
requirements for
and whether
WebPAS tables
each tumour type.
cancer is
(for linked
confirmed. Write
reporting)
this to WebPAS
automatically
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 36 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Phase 1 Tactical
for immediate
FCT
requirements
Enable external
referral
information to be
collected in
existing PMS to
capture referrals
out to tertiary
DHBs for initial
cancer treatment
Clinical intranet
cancer specialty
specific web
forms, with shared
generic data
elements and
expanded tumour
specific
information to
support the
clinical diagnostic
and treatment
processes, and
work towards
shareable patient
medical record
across the clinical
disciplines and
across DHBs
Application
changes and
development
required
Investigate and
promote use of
WebPAS external
referral
functionality.
Change
management
process to
support data entry
for this when the
external referral is
done. Not a
clerical process at
present
Start development
of web forms and
SQL Server
database
structures to
support specific
cancer types and
clinical audit
requirements that
will interface
directly with
regional MDM
processes. Prepopulate from
PMS and other
clinical
applications
where possible.
Work with
services that have
requested these
enhancements
initially
Clinical Intranet
cancer tumour
stream specific
MDM web forms
for shared access
and
Start development
of web forms and
SQL Server
database
structures to
support specific
Estimated time
and cost
2 days
discussion with
provider and
design.
WebPAS
application
changes with
code set up 3-4
days.
Change
management to
identify, train and
support clerical
and/or clinical
users to
electronically
record
Once datasets
are agreed:
Design of
integrated cancer
db with
allowance for
SMO user
requirements for
tumour specific
datasets. 2 days
each.
Web form
development for
each cancer
tumour or
specialty stream
takes about 4-6
days with user
collaboration and
testing.
Interface
development and
integrated design
with writeback to
PMS, testing – 48 hours each.
New security
roles, access
from HV 4-8
hours each.
Say 10 different
streams?
Once datasets
are agreed:
Design
expansion of
cancer db to
include generic
2012-10-15_ FCT Regional Implementation Plan Final.doc
Strategic
solution
Regional impacts
May be long term
solution for
external referrals
until all Midland
DHBs have
migrated to
Concerto.
Should then be
developed as part
of the clinical
workflow process
Requires linking
between initial
referral and
referrals out, then
to the referral
receipt at tertiary
DHB.
Use these forms
and datasets as a
basis for the
regional Concerto
Clinical Intranet
implementation –
forms
development and
clinical workflows.
At least half of the
strategic
development
would be covered
by these tactical
forms and
datasets
Will require
regional design
and agreement.
Use these forms
and datasets as a
basis for the
regional Concerto
Clinical Intranet
implementation –
Will require
regional design
and agreement.
Will require
regional design
and agreement.
Page 37 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Phase 1 Tactical
for immediate
FCT
requirements
documentation of
diagnosis,
treatment,
adjuvant therapy
and other
requirements for
informed clinical
decisions.
Collection of delay
reasons
Reporting FCT
information,
linking referrals to
inpatient waiting
lists for diagnostic
procedures, data
validation
processes and
analysis tools set
up.
Application
changes and
development
required
cancer types in
agreed multidisciplinary
meeting
proformas.
Support generic
meeting and
diagnostic
requirements plus
tumour specific
information.
Pre-populated
from other
applications
where applicable
No process
defined
SQL Server
based extracts for
regional linking,
data validation
reporting for
events with no
linked referrals,
no diagnosis etc.
Write MoH FCT
extract and set up
internal RS
reports for
Provider Arm
monitoring and
analysis. Addition
of FCT indicators
to Business
Intelligence cubes
for analyst use.
Estimated time
and cost
Strategic
solution
and tumour
specific MDM
datasets. 1 day
each
Web form
development and
testing 2-4 days
each.
New security
roles, access
from HV 4-8
hours each.
Say 10 different
streams?
forms
development and
clinical workflows.
Unknown at this
stage.
Will require
workflow process
and data collection
templates
Should be
portable to
Concerto based
collection methods
because the
agreed datasets
should not change
significantly
5 days report
specification and
rules logic design
4-5 weeks initial
report
prototypes,
identification of
error types for
DV reporting, set
up for linked
reporting tables,
imports of
regional datasets
and matching
processes etc.
Regional impacts
Because these are
mainly regional
MDMs, most
design and
database
requirements will
be done for the
migration to
Concerto forms.
Needs agreement
of regional cancer
datasets and
matching process
rules.
Ongoing
monitoring and
changes.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 38 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Waikato/Midland region
Ca
n
rD
Aria
HB
Re
fer
ral
GP Refer
ral
ED Refer
l
rna
Inte
Patient Data
ral
ral
fer
Re
ce
rT
Da rea
ta tm
en
t
iPM
t
en
Data Staging
Data Warehouse
WDHB FCT
Indicators
Da
ta
n
Ca
m
at
re
r T ta
ce Da
WDHB
Reporting
FCT Data
Ex
tra
ct
Oth
e
Breach
Reason
Waikato IS have worked with Waikato DHB and Midland Cancer Network staff to identify a proposed
solution to capture FCT indicators for Waikato DHB through to their inclusion in the regional FCT
database, as well as the creation of the regional FCT database.
Aesculapius
Oncosoft
Local Solution
WDHB
FCT Data
Tairawhiti
FCT Data
Lakes
FCT Data
BoP
FCT Data
Regional Solution
(Hosted at WDHB)
Data
Load
Data L
oad
MoH
Reporting
Data Load
Load
Data
Regional FCT
Indicators
The Waikato patient management system (iPM) will be modified to allow a ‘High Suspicion of Cancer’
to be captured from the patient referral received by the Waikato DHB. This data, along with other key
patient information, will be extracted to the existing data warehouse. New data extract routines from
the cancer treatment systems will need to be developed to append treatment information to the
patient data within the data warehouse. Once all cancer patient data is collated in the staging tables,
a new FCT database will be built and populated with specific FCT indicator data. A simple application
will be developed to allow clinicians to enter the reason for a delay in treatment against any given
patient, which may have caused a breach in the best practice timeframes. Some new reports will be
required to allow visibility of the Waikato DHB FCT data.
It has been proposed that Waikato DHB host a regional FCT database where Bay of Plenty, Lakes,
Tairawhiti and Waikato DHB information can be consolidated to provide a Midland view of the FCT
indicator data. Data extracts would need to be provided at the local DHB level and loaded into a
regional database.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 39 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Appendix E: Midland FCT Work Group
Ashworth, Natasha – Tairawhiti DHB
Barber, Harry – Tairawhiti DHB
Boles, David – Lakes DHB
Bunker, Wendy – Lakes DHB
Chittenden, Jane – Lakes DHB
Coles, Clare – Waikato DHB
Collier, Rachael – Waikato DHB
Donnell, Andre – Waikato DHB
Donnell, Shelley – Waikato DHB
Douglass, Darren – Regional IS
Goodman, Grant – Regional IS
Groufsky, Darryl – Midland Cancer Network
Hamilton, Margie – Midland Cancer Network
Jonkers, Michiel – Waikato DHB
McKelvie, Neil – Bay of Plenty DHB
Meihana, Te Pare – Tairawhiti DHB
Poor, Alex - – Midland Cancer Network
Ross, Catherine – Bay of Plenty DHB
Smith, Andrew – Waikato DHB
Smith, Jan - – Midland Cancer Network
Stevenson, David – Tairawhiti DHB
Taumanu, Paul – Waikato DHB
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 40 of 44
Midland Regional Faster Cancer Treatment Implementation Plan, September 2012
Appendix F: Glossary of Terms
Term
Description
Date of most
valid
diagnosis
The date on which the patient was definitively diagnosed with a particular condition
or disease.
Decision-totreat
The decision to treat date is the date when the decision was made for the patient’s
treatment plan or other management plan, following discussion between the patient
and the clinician responsible for treatment
Delay code
When the time taken for a patient to track through the patient pathway is outside the
time identified for the indicator the overall time taken and the main reason for the
delay must be reported
DHB
District Health Board
FCT
Faster Cancer Treatment
First MDM
meeting date
Date on which the patient was first discussed at a MDM.
MoH
Ministry of Health
NHI
Organisation
PMS
Practitioner
Published
Documents
National Health Index
The NHI number is the unique identifier assigned to each patient using health and
disability support services and is the cornerstone of patient-related transactions
within the hospital and primary healthcare facilities, both clinical and administrative.
An organisation is the entity that provides services of interest to, or is involved in,
the business of the health care service provision. There may be a hierarchical
(parent–child) relationship between organisations.
Patient management system
A person who is, or is deemed to be, or has been, registered with a Responsible
Authority as a practitioner of a particular health profession under the Health
Practitioners Competence Assurance Act 2003.
A published document in the context of the FCT project is a finalised/approved
document that has been validated and generated into the stipulated format as
defined by the recipient preferences, e.g. PDF, Word etc
The receipt of referral date is the date the initial referral from primary care including
dental is received into secondary care.
Electronic referrals
Best practice is for referrals to be submitted electronically. Where referrals are
submitted electronically the date of receipt of referral is the submission date on the
electronic referral
Referrals
Letter or faxed referrals
When referrals are made by letter or fax the date of receipt of referral is the date
with which the referral is stamped as having first being received in secondary care
Telephone referrals
When referrals are made by telephone the date of receipt of referral is the date
stamped on the formal referral (following the telephone conversation) when it has
been received in secondary care
Source of
Referral
The source of the referral is defined by the facility / health professional that made
the referral.
Type of First
Treatment
The type of first treatment is defined as the treatment or other management that
attempts to begin the patient’s first treatment, including palliative care.
2012-10-15_ FCT Regional Implementation Plan Final.doc
Page 41 of 44