Download 1 - Central Cancer Network

CCN Faster Cancer Treatment Regional Implementation Plan – final
New Zealand Regional Cancer Networks
Regional Implementation Plans for
Faster Cancer Treatment Indicators
Regional Information Plan Template and Guidelines
The Ministry of Health has required that regional collectives of District Health Boards are
to prepare Regional Implementation Plans by the 30th June 2012. The primary purpose
for developing FCT indicators is as a mechanism to inform and drive service
improvement for timely access to health services and ultimately to improve patient
outcomes for:
 Patients referred with a high suspicion of cancer
 Patients diagnosed with cancer
These plans are not intended to be high level strategies: they are implementation plans
that align with the national intent and focus initially on the activities required to achieve
a robust means to provide Faster Cancer Treatment indicators, from 1 July 2012
ongoing.
District Health Boards are expected to be in a position to commence execution of the
Regional Implementation Plans immediately, with monthly reporting commencing from 1
July 2012. The plans are the basis on which DHBs will be accountable for delivery of the
Faster Cancer Treatment indicators to the Ministry of Health.
The NZ Regional Cancer Network Managers and the Ministry of Health Cancer Team will
review the regional plans in order to determine national alignment and identify any
conflicts or dependencies between regional plans.
This does not negate the
responsibility for regions to work together to resolve any inter-regional issues and
leverage opportunities related to the achievement of national goals.
The Regional Implementation Plan template is intended to:
 Provide guidance to regional plan authors on the content and level of detail that
should be included,
 Assist the regional planning process by providing a template and standard
content that can be used or adapted,
 Assist those who will read the regional plans by ensuring a level of consistency
between the plans from different regions,
 Simplify the comparison and consolidation of regional plans.
The template includes guidelines in italics (these would not appear in the plan itself).
Suggested regional plan content is non-italicised.
NZ Regional Cancer Network Managers
Authors:
NZ RCN Managers
Last Updated:
28 May 2012
Document Name:
NZ RCN Tumour Stream Standards & FCT Project
Version:
1.3
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CCN Faster Cancer Treatment Regional Implementation Plan – final
Faster Cancer Treatment
Central Region Implementation Plan
2012 / 2013
Version: Final v0.4
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CCN Faster Cancer Treatment Regional Implementation Plan – final
Document Control
Sign Off Sheet –
This Central Region Implementation Plan has been approved by the Regional Faster Cancer
Treatment Steering Group and Regional DHB GMs Planning and Funding and CCOs. The following
signature indicates approval and acceptance of the document:
Name
Role
Signature/Date
Mary Bonner
Lead CEO for CCN
____________________
____/____/____
Compilation and Distribution Summary
Version
Date
Author
Distributed to
Comments/Feedback
0.1
28.6.12
Jo Anson
FCT Steering Group
Ministry of Health
GMs
Planning
Funding
COOs

Equity focus to be more visible

Describe methodology

Describe the MDHB / CCDHB
Clinical analyst in terms of functions
not positions

Describe the link of the MDHB /
CCDHB Clinical analyst functions to
the hubbed DHBs

Strengthen
focus
on
improvement opportunities

More inclusive of primary care
&
service
0.2
6.7.12
Jo Anson
FCT Steering Group
Ministry of Health
GMs
Planning
&
Funding
COOs
DHB
FCT
Implementation Groups

HBDHB feedback re including the
wider FCT programme of work in the
exec summary and scope – sections
updated. Also querying level of
regional resource versus district
resource required – flexibility with
plan roll-out going forward confirmed
with MOH.
0.3
14.8.12
Jo Anson
GMs
Planning
Funding
COOs
&

Awaiting confirmation from MOH re
funding to support the plan
0.4
16.10.12
Jo Anson
FCT Steering Group
Ministry of Health
GMs
Planning
&
Funding
COOs
DHB
FCT
Implementation Groups

Plan revised to include learnings to
date - changes made to size and
scope of support roles and reduction
in IT scope and costs

Revised plan submitted to Ministry
and full funding approval received
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CCN Faster Cancer Treatment Regional Implementation Plan – final
Table of Contents
Executive Summary............................................................................................... 5
1 Document Purpose ........................................................................................... 6
2 Scope............................................................................................................. 6
3 Strategic Drivers ............................................................................................. 7
3.1 Faster Cancer Treatment Initiative ............................................................... 7
3.2 Regional Services Plans............................................................................... 8
3.2.1 Regional DHB Service Plan........................................................................ 8
3.2.2 Regional Information Services Plan ............................................................ 8
3.3 National Programmes ................................................................................. 9
4 Regional Implementation Plan ........................................................................... 9
4.1 Approach .................................................................................................. 9
4.1.1 Methodology ........................................................................................... 9
4.1.2 Key Principles ....................................................................................... 10
4.1.3 Critical Success Factors .......................................................................... 10
4.1.4 Regional Implementation Plan - Process ................................................... 11
4.1.5 Regional Implementation Plan - Technology .............................................. 11
4.1.6 Regional Implementation Plan - People .................................................... 11
4.2 Governance and Management .................................................................... 13
4.2.1 Governance Structure ............................................................................ 13
4.2.2 Clinical Leadership and Engagement ........................................................ 13
4.2.3 Management ......................................................................................... 13
4.2.4 Monitoring ............................................................................................ 13
4.3 Current State .......................................................................................... 14
4.4 Projected Future State .............................................................................. 15
4.5 Objectives ............................................................................................... 16
4.5.1 National Objective(s). ............................................................................ 16
4.5.2 Regional Objective(s) ............................................................................. 16
4.5.3 DHB specific initiatives ........................................................................... 18
4.6 Indicative Costing .................................................................................... 19
4.7 Risk Management ..................................................................................... 19
4.8 Assumptions, Dependencies and Constraints ............................................... 20
Appendix A: ....................................................................................................... 21
Appendix B: ....................................................................................................... 23
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CCN Faster Cancer Treatment Regional Implementation Plan – final
Executive Summary
Vision and Key Goals
The Ministry of Health has required each of the four regions to develop a Faster Cancer
Treatment (FCT) Regional Implementation Plan by June 2012. This is necessary to
support the implementation of faster cancer treatment practices across all services that
provide diagnostic or treatment services to people referred urgently to DHBs with high
suspicion of cancer. This means DHBs must understand the application of nationally
agreed data items, and align the required data collection from services such as referral
triage/ management, diagnostics, and surgical and non-surgical cancer treatment.
Expected Outcomes
The intention is to support robust national data collection and reporting within the three
year timeframe, being 1 July 2012 - 30 June 2015. In addition key enablers including
MDM development, establishment of care coordination roles and the development and
implementation of national tumour stream standards will be progressed under this
programme of work.
Governance and decision making approach
The DHBs own and manage the implementation of the FCT indicators via DHB FCT
Implementation Groups as a means to understand and improve the patient journey.
The Regional FCT Steering Group will guide and monitor FCT programme development
for the region.
The Central Cancer Network will facilitate and coordinate the FCT programme for the
region.
Recommendations
The following staged process is planned for the collection and reporting of the FCT
indicators for the region:
Period
July 2012 to Dec
2012
Mid Term
Longer Term (2015+)
Expected Processes
DHB of Domicile compile FCT indictors
based on information provided by the
various treating DHBs
Regional consolidation with an
emphasis on automating processes
where it is viable
CRISP enabled information
management, national reporting
framework supported by national
datasets and business rules
Investment approach and cost, if appropriate
This approach requires investment in personnel for the first year, over an above the
resource required in each DHB. It is proposed that a Regional FCT Project Manager, a
Regional Cancer Data Manager and Clinical Analysts for the two major DHBs of service
be established. With respect to IT, investment is signalled for the implementation of a
regional consolidation tool / process. Total indicative cost for the recommended approach
is $380K - $400K for 2012/13.
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CCN Faster Cancer Treatment Regional Implementation Plan – final
1 Document Purpose
This project plan pertains to the production of Faster Cancer Treatment Regional
Implementation Plans.
This Faster Cancer Treatment Regional Implementation Plan is an implementation plan
that aligns with, and supports, the Ministry of Health’s Faster Cancer Treatment
initiatives and the clinical and business service needs of the region. It covers a two year
time period and has a strong focus initially on the activities required to achieve collection
of Faster Cancer Treatment indicators, commencing July 2012. Subsequent activities are
directed toward robust capacity building, including IS/IT capacity, to support ongoing
collection according to nationally agreed Ministry of Health definitions and criteria.
The document describes how regional implementation plans are to be governed,
managed and delivered. It details those activities that will be completed, the funding,
workforce capability and business process change required for a successful
implementation and the clinical and business benefits they will deliver.
This plan will be reviewed monthly and is the basis on which DHBs are to be held
accountable for the collection of Faster Cancer Treatment indicators.
The sponsor for the Regional Implementation Plan is Clinical Director Central Cancer
Network and the Manager Central Cancer Network. The FCT Project Manager is directly
accountable for its delivery.
The primary audience for this Plan are DHB Boards and Executive Teams, Information
Systems Managers, Information Management teams and decision support staff, and
cancer services clinicians and managers.
2 Scope
This Regional Implementation Plan describes services across Taranaki, Whanganui,
MidCentral, Hawke’s Bay, Wairarapa, Hutt Valley and Capital and Coast DHBs and
concurs with nationally agreed inclusions/exclusions as below:
Project Coverage

All DHB adult outpatient and inpatient services in the
referrals for patients with a high suspicion of cancer
 All DHB adult outpatient and inpatient services in the
patients with a high suspicion of cancer
 All DHB adult outpatient and inpatient services in the
cancer treatment
 Data points clarified eg collection starting point and
2012/13
Project Coverage Exclusions



Scope

Central region that receive
Central region that assess
Central region that provide
reporting requirements for
Paediatric services
Primary care service providing cancer treatment
Private providers of cancer treatment
Exclusions from this Project
Significant clinical process change
Note that this plan describes the activities identified for 2012/13 which are intended to
result in the collection of the prescribed baseline measures.
This process is
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developmental and will require consideration and review as the programme is developed
through national and regional process.
Stakeholders are encouraged to work
collaboratively to both identify and resolve issues are they arise.
In addition key enablers including MDM development, establishment of care coordination
roles and the development and implementation of national tumour stream standards will
be progressed under this programme of work.
3 Strategic Drivers
This section describes the context in which the Regional Implementation Plan sits, noting
overlaps with major sector activities which have an impact on the region.
3.1 Faster Cancer Treatment Initiative
‘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 within14 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).
The implementation of the FCT indicators (the indicators) has been identified as a
priority for District Health Boards (DHBs) in the 2012/13 DHB Planning Package. The
implementation of the indicators has also been endorsed by the Cancer Control Steering
Group (CCSG), and the Cancer Treatment Advisory Group (CTAG).
This FCT initiative 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
 quality: all people receive excellent services wherever they are
 financial sustainability: all services make the best use of available resources.
The FCT project aligns with the following goals of the New Zealand Cancer Control
Strategy:
 goal 3, Objective 1: Provide optimal treatment for those with cancer
 goal 3, Objective 2: Develop defined standards for diagnosis, treatment and
care for those with cancer
 goal 3, Objective 3: Ensure patient-centred and integrated care for those with
cancer, their family and whānau.
National vision/intent
The faster cancer treatment (FCT) project focuses on the outcome of patients getting
faster, quality, cancer treatment from the time their cancer diagnosis is suspected. This
project includes implementation of three FCT indicators. During 2012/13 the DHBs will
work to establish baseline data, using retrospective reporting, against the three FCT
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CCN Faster Cancer Treatment Regional Implementation Plan – final
indicators. The nature of the reporting against the FCT indicators will change, with the
reporting on the length of time taken moving to real-time monitoring of each patient
progressing through the pathway in the future.
The four Regional Cancer Networks (Central, Midland, Central and Southern) have been
engaged by the Ministry to deliver a joint high level project plan for the development of
tumour stream standards and patient pathways from April 2012 to June 2013.
The project will result in the development of:



Eight tumour stream standards by 30 June 2013
Regional faster cancer treatment implementation plans by 30 June 2012,
noting that plans must be flexible to adapt to the dynamic environment
Care coordination stocktake by 30 June 2012
This Faster Cancer Treatment Regional Implementation Plan is a key priority initiative of
the faster cancer treatment project and forms part of Stage 1 of the wider Faster Cancer
Treatment programme.
3.2 Regional Services Plans
3.2.1 Regional DHB Service Plan
The 2012/13 Central RSP includes the following relevant activities:
Implement the regional initiatives identified in the National Cancer Programme Work
Plan with regional cancer networks. This will include:
 improving the functionality and coverage of multi-disciplinary meetings (MDMs)
by June 2013
 beginning to implement regional clinical data repositories for cancer – phase 1
priorities implemented by June 2013
 implement the agreed priorities in the regional implementation plans for the
faster cancer treatment indicators - phase 1 priorities implemented by June 2013
 identify solutions which strengthen service integration across the region by June
2013
 implementing priority actions from the Medical Oncology Models of Care – phase
1 priorities implemented by June 2013
(reference: Central RSP 2012/13)
3.2.2 Regional Information Services Plan
The Central Region Information Systems Plan (CRISP), moves the DHBs to a suite of
shared, standardised and fully integrated information systems that will enhance clinical
practice, drive administrative efficiencies, enable regionalisation of services and reduce
current operational risks. The scope and initial focus of the CRISP Programme is to
achieve Phase 1 (foundation – shared care) of the Central Regional Services Plan’s goals.
These include:
1. the implementation of a federated regional Picture Archiving and Communication
System (PACS) to provide improved access to radiology reports and images
across the region together with a regional PACS archive to minimise storage
costs. This activity supports the radiology vulnerable service
2. the implementation of regional clinical and patient administration data
repositories which will also be available to all primary and secondary clinicians
across the region
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3. the implementation of a regional Patient Administration System (PAS) which
includes the replacement of the three end-of-life patient administration systems
at MidCentral, Wairarapa and Whanganui DHBs with a single system.
4. the implementation of a regional Clinical WorkStation (CWS) for hospital clinicians
in the region with access by primary care and other community healthcare
providers
5. the establishment of a regional infrastructure to give clinicians one logon, one
password, and fast and convenient access to information
6. The implementation of a service management framework to ensure that service
design and management, release, control, supplier and resolution processes are
coordinated for regional systems.
(reference: Central RSP 2012/13)
3.3 National Programmes
The Ministry has advised the following national information service developments which
may impact on the FCT programme:

National View of Cancer - not much impact or value for FCT until regional clinical
data repositories are mature and available to it. The National View of Cancer
"joins up" six national collections - Cancer Register (diagnosis), NMDS (in-patient
and day-patient treatment), NNPAC (out-patient and emergency treatment),
Pharms (dispensed pharmaceutical cancer treatment), NHI (about the patient),
and Mortality (under-lying and contributory causes of death). None of the
individual collections contributing to the National View of Cancer will be of use to
FCT.

National Patient Flow - definite impact and value but not for 2 to 3 years

Cancer Registry - probable value but primarily for retrospective validation of
patient cohorts

Regional Clinical Data Repositories - e.g. TestSafe, METRIQ. Definite impact and
value but not for 1 to 2 years
4 Regional Implementation Plan
4.1 Approach
4.1.1 Methodology
The approach to developing the plan has included the following key steps:
 Network Managers developing and agreeing the project plan and implementation
plan format

DHBs received background documents and templates relating to a process and
systems review on the 5th April 2012. Follow-up teleconferences were held with
members of the FCT Implementation Groups in each DHB

DHBs completed their reviews and provided this information back to CCN/TAS for
collation and analysis mid May

A preliminary meeting was been held with members of the CRISP team to identify
key linkage areas

A regional workshop was held on the 24th May bringing together representatives
from DHBs (DSU, CIOs, Managers, Clinicians) to discuss proposed short term and
longer term mitigation actions. MOH and CRISP were also in attendance
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
Progress reports from the four regions were discussed at the NZ Regional Cancer
Network collaborative meeting (RCNs, MOH) on the 5th June

The draft plan was circulated to DHBs on the 11 th June and Jo Anson and Kevin
Sharkey (Central TAS) met with each DHB during the last two weeks of June to
discuss the wider FCT programme and gather feedback on the draft plan and
proposed reporting framework

A draft plan was discussed with the GMs Planning and Funding and COOs on the
27th June

A draft plan was provided to the MOH by the 28th June

CCN attended a meeting with the Ministry Cancer Team, NHITB and Southern
Cancer Network to collectively review the plans and discuss where $1m funding
for information system improvement will be invested (Budget 2012 – Cancer
letter, 31st May 2012)

The Regional FCT Steering Group reviewed and approved the draft at a
teleconference on the 4th July

The updated final draft was provided to the Ministry on the 6th July 2012

DHB and regional sign-off processes to follow in July/Aug 2012
4.1.2 Key Principles
The implementation plan aims to:
 Assist the improvement of cancer patient journeys
 Address equity issues relating to cancer journeys (HEAT assessment to be
undertaken for each delivery component of this plan)
 Clearly locate the responsibility for FCT collection and reporting with DHBs
 Enable consistency and co-ordination across tumour streams and across the FCT
pathway
 Provide sufficient resource to support the FCT implementation
 Enable DHBs to evolve and progress the FCT indicator collection and reporting
process
 Enable DHBs to works with Clinicians, Team Support and MDM Co-ordinators to
identify processes that compliment rather than duplicate and confuse existing
processes
 Identify gaps in the data
 Enable DHBs to use all data resources available to complete the indicators
 Enable DHBs to make progress in increasing the proportion of patients included in
the indicators
4.1.3 Critical Success Factors
Critical Success Factors for implementation of FCT Indicators are:
1. The capability to submit data in accordance with the Ministry of Health
performance indicator requirement reporting period 2012/2013
2. The capability to develop and improve the FCT indicator process and data quality
on a month by month basis
3. An agreed regional approach to reporting FCT indicators to the Ministry of Health
on a monthly basis
4. Collection and reporting data by patient domicile DHB, regardless of where cancer
treatment is provided
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4.1.4 Regional Implementation Plan - Process
The following staged process is planned for the collection and reporting of the FCT
indicators for the region:
Period
July 2012 to Dec 2012
Mid Term
Longer Term (2015+)
Expected Processes
DHB of Domicile compile FCT
indicators based on information
provided by the various treating DHBs
Regional consolidation with an
emphasis on automating processes
where it is viable
CRISP enabled information
management, national reporting
framework supported by national
datasets and business rules
4.1.5 Regional Implementation Plan - Technology
The CCN region currently does not have a stable ICT foundation to support the FCT
programme initially. Across the seven DHBs there is a great variation in ICT capability
which will be addressed by CRISP in the longer term, i.e. 2-3 years.
Therefore the following considerations have been taken into account in the approach
described above:
 Decisions regarding changes to PAS to enable capture and reporting of FCT
indicators will be at the discretion of each DHB (particularly relevant for those
DHBs with systems at the end of their lives)
 CRISP will be the vehicle for ICT development to support the FCT programme in
the longer term. The FCT programme is recognised as a key piece of work to
inform the detailed design phase.
 Interim considerations include minor programming to assist with automating data
consolidation processes
Therefore this region will need to rely on people-based solutions in the short term.
4.1.6 Regional Implementation Plan - People
The following new positions are recommended to enable the delivery of this plan for
2012/13. These positions are additional to resource which DHBs will be committing
internally to this programme.
These roles will be limited to a 12 month timeframe, with ongoing requirements being
identified during planning for 2013/14. Ongoing requirements will depend on many
factors including the robustness of the regional consolidation process implemented and
the pace of planned ICT developments, both regionally and nationally.
The Central region requests that the Ministry of Health fund these positions for a 12
month period from appointment.
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Regional FCT Project Manager
It is recommended that a fixed term Regional FCT Project Manager (1.0 FTE) be
recruited into the Central Cancer Network to work across all Central Cancer Network
DHBs.
The Regional FCT Project Manager will:
 Project manage and co-ordinate the FCT Regional Implementation plan with a
specific focus on the FCT indicators and MDM development activities in this plan
 Assist with evolving data collection and reporting processes and build
relationships across the region
 Become familiar with all regional and national initiatives that impact on the FCT
initiative, identify initiatives that will facilitate the FCT process and engage with
relevant project teams to enable this
 Maintain alignment across the project areas of the FCT indicators, MDM
development, Cancer Care Co-ordination and tumour stream standard
development
 Link with FCT project managers across the other RCNs and Ministry team to
maximise alignment and shared learnings
Regional Cancer Data Analyst
It is recommended that a fixed term Regional Cancer Data Analyst (0.3 FTE) be
recruited. This role will be located at TAS and function within the CCN analytical contract
with TAS.
The Regional Cancer Data Analyst will:
 Provide regional expertise on FCT indicator definition and inclusion
 Provide regional level reporting of FCT data, e.g. tumour stream data views to
support regional service development
 Undertake or guide specific clinical or process audits as required
 Assist with evolving data collection and reporting processes and continuosly refine
the FCT Reporting Framework
 Work with the other networks to develop and manage appropriate information
flows across networks
 Work with the Ministry to inform FCT data documentation
DHB FCT Trackers
It is recommended that fixed term FCT Trackers are implemented in CCDHB and MDHB
as the two major DHBs of service in the region (1FTE per DHB).
The FCT Trackers will:
 Work with the cancer centre’s referring DHBs to maximise inward and outward
information flows
 Be responsible for ensuring that data is reliable and complete, and that monthly
reports are generated, checked and submitted
 Identify opportunities to improve data collection or entry to ensure processes
support a business as usual approach into the future
 Contribute to the wider FCT programme across the region
DHB FCT Clinical Advisors
It is recommended that fixed term FCT Clinical Advisors are implemented in CCDHB and
MDHB as the two major DHBs of service in the region (0.4FTE per DHB).
The FCT Clinical Advisors will:
 Provide clinical expertise to validate FCT data, including delay code validation
 Using the FCT data, identify areas for improvement and work with relevant DHB
FCT Implementation groups to address these to ensure processes support a
business as usual approach into the future
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4.2 Governance and Management
4.2.1 Governance Structure
The DHBs own and manage the implementation of the FCT indicators via DHB FCT
Implementation Groups as a means to understand and improve the patient journey (see
appendix A for TOR).
The Regional FCT Steering Group will guide and monitor FCT programme development
for the region (see appendix B for TOR).
The Central Cancer Network will facilitate and coordinate the FCT programme for the
region.
The Regional FCT Project Manager will provide quarterly reports to the Steering Group.
These reports will include:
 Risk Register Reporting
 Issues Register Reporting
 Audit reports
 Compliance Reports
 Performance Reports
 Change Request Reports
4.2.2 Clinical Leadership and Engagement
Clinical leadership and engagement is achieved as follows:
 Each DHB will form a FCT Implementation Group with representation from
relevant clinical teams.
 Regional clinical leadership will be provided by the CCN Clinical Director, CCN
Nurse Director and CMA representative. The Regional Steering Group will also
provide guidance to DHBs on clinical engagement strategy
 Consultation with clinicians across the cancer streams has been initiated and is
ongoing
4.2.3 Management
Strategic Management
The Central Cancer Network Manager has management accountability for the production
of the FCT Regional Implementation plan.
The DHB FCT Service Management Leads have management accountability for the FCT
implementation in each DHB.
Strategic and Operational Information Management (IM)
The Central DHBs will form a regional FCT information management group. This group
will include the FCT Project Manager, Regional Analyst, CCDHB/MDHB Clinical Analysts,
DHB ICT and DSU leads from across the region. The group will progress and resolve FCT
IM and reporting issues. It is anticipated that the group will develop relationships with
similar groups in other regions.
4.2.4 Monitoring
See 4.2.1
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4.3 Current State
In summary DHBs have identified a range of issues relating to the capture and reporting
of the data elements to inform the FCT indicators, including:
 It is difficult to connect events across the tumour stream pathway especially
when these pathways span different DHBs and different services within DHBs
 There is currently no single episode ID to support active patient management or
data reporting
 No consistent method to add a High Suspicion of Cancer flag to enable
prospective patient management
 Variations in interpretation of some data elements will occur if business rules
aren’t agreed across the region (?nationally)
 Capture of these data elements currently is a combination of PAS and paper
based due to variability in systems across the region
 Most PAS systems in the region are coming to the end of their life therefore IT
based solutions are not feasible in the short term. The Central Region Information
Systems Plan (CRISP) will address this in the medium term.
An overview of the current state is provided below (Key):
 Green – can be reported
 Amber – variability in DHB’s ability to capture and/or report this information –
work required
 Red – currently this is not able to be identified or reported – work required
Mandatory Data Elements
Data Element
Current State
Ethnicity
DHB of Domicile
DHB of receipt of referral
All DHBs indicate that this is available
Element is in the PAS mapped from Domicile code
Able to be captured by DHB of Service but not necessarily
visible to DHB of Domicile
This is recorded in all DHBs manually (date stamp on
referral letters) but only some DHBs have a PAS field
where it can be captured
All DHBs indicate that this is available
Date of receipt of referral
Date of First Specialist
Assessment
Primary site of
classification ICD
(Grouped into tumour
stream)
Date of Decision to Treat
Type of first Treatment
Date of first treatment
DHB of Service for first
treatment
Inpatient events have ICD codes attached to them but not
outpatient events.
Business rules required to separate the treatment of
cancer from other inpatient events.
Generally site is known when treatment commences for
radiotherapy or chemotherapy and held within the
relevant clinical system.
Information is also maintained in Cancer Registry but
timely access is an issue.
Variations in interpretation of proxies
DHB of Service can identify this but not necessarily visible
to the DHB of Domicile
All DHBs identified data available for RT/Chemo /Surgery.
Issue getting this for palliative care, no treatment etc
Facility code to be hard coded into data extract
Non-mandatory Data Elements
Data Element
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CCN Faster Cancer Treatment Regional Implementation Plan – final
National Health Index
(NHI)
Age
Episode (of care)
identification (ID)
Source of referral
Urgency of referral
Date patient informed of
diagnosis
Date of most valid
diagnosis
Date of Multidisciplinary
Meeting (MDM)
All DHBs indicate that this is available
This can be calculated from date of birth which can be
reported with NHI
No current ID process in place across DHBs. This is an
area that needs to be addressed by CRISP, however
Taranaki DHB has identified a process of creating a
episode of care for each cancer referral. Taranaki DHB is
outside of the Central Region’s CRISP Project.
This data element is readily identifiable but is currently
not captured in PMS systems
DHB assign a status but cannot say if it is suspicion of
cancer related
Not recorded or managed in a formal way to assist with
reporting. Further clinical decision within DHBs required.
Not recorded or managed in a formal way to assist with
reporting. Further clinical decision within DHBs required.
This data element is readily identifiable but is currently
not captured in PAS systems
4.4 Projected Future State
The region sees the FCT programme as a three stage process:
Stage
Focus
Stage 1
(2012/13)
Data

Stage 2
(2013/14)
Stage 3
(2014/15
onwards)
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Enabling DHBs to capture and report on baseline data
relating to the mandatory data elements in a timely
and cost effective manner
 Implementing a regional consolidation process
 Informing CRISP re developmental requirements for
the capture and reporting of the FCT indicators
 Building knowledge and capacity in the region around
the FCT programme
Service Improvement
 Utilising the FCT data to identify areas where patient
pathways require improvement
 Continuing focus on MDM development
 Understanding the care coordination requirements in
the region relating to the FCT programme and
planning for investment (Ministry funded)
Data
 Increasing DHBs abilities to capture and report on
baseline data relating to the non-mandatory data
elements
Service Improvement
 Utilising the service standards to take a tumour
stream focus on service improvement
 Focus on identification of high suspicion of cancer in
primary care
 Continuing to embed the care coordination resource in
the region
Data
 Utilising CRISP enabled or national ICT solutions to
support DHBs to pro-actively capture and report FCT
indicators
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CCN Faster Cancer Treatment Regional Implementation Plan – final
Service Improvement
 Enabling prospective management of the patient
through their cancer pathway
This plan focuses on Stage 1 activities and should:
• Inform the region about the FCT programme, including primary,
secondary/tertiary services
• Clearly locate the responsibility for FCT collection and reporting with DHBs
• Enable consistency and co-ordination across tumour streams and across the FCT
pathway
• Provide sufficient resource to support the FCT implementation
• Align with the investigative, iterative spirit of 2012/2013 data collection
• Identify clear responsibilities for indicator reporting
• Enable DHBs to works with Clinicians, Team Support and MDM Co-ordinators to
identify processes that compliment rather than duplicate and confuse existing
processes
• Enable DHBs to use all data resources available to complete the indicators
• Enable DHBs to make progress in increasing the proportion of patients included in
the indicators
• Align with Tumour Stream model
4.5 Objectives
4.5.1 National Objective(s).
These are the activities that have been identified at this time which require a national
focus (MOH Cancer Team, National IT Board, NZ Regional Cancer Networks). These have
been raised at a national level for consideration:
 Monitor national IT direction and how this will enable/impact on the FCT
programme
 Ensure work on regional data repositories maximises the ability to link national
datasets
 Agree relevant surgical procedures so these can be mapped to surgical codes
(Scottish definitions document)
 Investigate Lab notification process for flagging diagnosis
 Work with the regional cancer networks to identify care coordination solutions
 Identify and address any privacy concerns relating to the multiple transfer of
identifiable data
 Identify if a consistent list of exception codes can be developed for both the FCT
and RO/chemotherapy reporting
4.5.2 Regional Objective(s)
These are the activities that have been identified that require a regional focus, and form
the basis of the regional plan
Reporting of FCT Indicators
Activities
When
Who Leads
Establish a Regional Cancer Data
Analyst role
Establish FCT Trackers and Clinical
Advisor roles in CCDHB / MDHB
Develop FCT reporting framework
which includes business rules, roles
Nov
2012
Nov
2012
Jul 2012
CCN
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CCDHB / MDHB
FCT Project
Manager
Measures /
Milestones
Role in place
Functions in
place
Framework in
place
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CCN Faster Cancer Treatment Regional Implementation Plan – final
and responsibilities and timeframes
Commence monthly reporting of
FCT indicators and refine processes
DHBs / TAS
Investigate options for enabling a
regional data consolidation process
Aug –
Dec
2012
Jul-Sep
2012
Robust process
in place
Review and approve recommended
solution
Oct
2012
FCT Steering
Group
Implement solution (subject to
funding)
Oct-Dec
2012
FCT Project
Manager
Process in
place
Work with the CRISP team in the
detailed design phase to identify the
PAS requirements to support
regional cancer information
management
Work with other networks to
determine the approach for
reporting across network
boundaries
Implement contractual
requirements for Hospice reporting
to include relevant data elements
Establish and implement an audit
process and schedule
Jul 2012
– Nov
2012
CCN Cancer
Information
Management
Group
Criteria
identified
Dec
2012
CCN / MCN /
NCN / SCN
Reporting in
place
Jul 2013
DHBs
Contracts in
place
Jul 2013
Regional
Cancer Data
Analyst
Audits
commenced
FCT Project
Manager
Wider FCT Programme
Activities
When
Who Leads
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
Establish FCT Implementation Groups
in each DHB
Establish a Regional Cancer
Information Management Group
Develop a regional communication
strategy for the FCT programme
MDM development plan continues to
enable access to timely MDM
decision-making
Implement care coordination resource
in line with nationally developed
service specifications and contracting
Nov
2012
CCN Network
Manager
Jul
2012
Jul
2012
Jul
2012
Jul
2012
Jul
2013
CCN Network
Manager
DHBs
CCN hosts the national Haematology
Work Group and develop standards
for Lymphoma and Myeloma
pathways
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Oct
2012
onward
s
Jun
2013
FCT Project
Manager
FCT Project
Manager
CCN MDM
Project
Manager
MOH / CCN /
All DHBs
CCN Tumour
Stream
Project
Manager
Measures /
Milestones
Role in place
Group
established
Groups
established
Group
established
Strategy in
place
Increased
access to
MDMs
Coordination
roles in place
National
Standards
Developed
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CCN Faster Cancer Treatment Regional Implementation Plan – final
Activities
When
Who Leads
Contribute to the other tumour
stream work groups to develop
standards as required
ongoin
g
Develop Stage 2 plan identifying
actions for 2013/14 and feed into RSP
and DHB AP planning processes
Feb
2013
CCN Tumour
Stream
Project
Manager
CCN FCT
Project
Manager
Measures /
Milestones
National
Standards
Developed
Plan completed
RSP / DHB APs
informed
4.5.3 DHB specific initiatives
In addition to the various system and process changes which DHBs are able to make to
collect and report on the FCT indicators, they have also commenced the following work
around the wider FCT programme as notified at the end of June 2012.
Taranaki DHB
 FCT Implementation Group being established
 Implementing measures to address risks with Taranaki not being encompassed
with the Central Region. Risks include non-alignment with CRISP or regional
decision making processes. A Taranaki member has been specifically identified for
regional FCT Steering Group to mitigate this
 Processes being established to ‘flag’ suspected cancer patients in PAS at entry to
secondary services
 Identifying care coordination resources required to pro-actively manage patients
through the pathway. Likely to require resource over and above what is currently
budgeted
Whanganui DHB
 FCT Implementation Group being established
 Aiming to get clinicians engaged using data on the FCT indicators to identify areas
for improvement
MidCentral DHB
 FCT Implementation Group being established
 Currently working through the reporting requirements as both a DHB of Domicile
and a large DHB of Service
 Continuing development of local and regional MDMs
Hawkes Bay DHB
 FCT Implementation Group established
 Working to understand the tumour pathway (bowel initially) including key
decision points to enable improvements. They will then use this information to
assist with mapping other pathways.
 Currently scoping work around improving MDM access and functionality
 Investigating e-referral processes
Wairarapa DHB
 Considering their advisory group structure for electives, diagnostics and the FCT
work – potential establishment of a patient flow group to manage across these
pieces of work
 Currently reviewing oncology nursing resource
Hutt Valley DHB
 FCT Implementation Group to be established
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CCN Faster Cancer Treatment Regional Implementation Plan – final

Working with CCDHB re MDM development
Capital & Coast DHB
 FCT Implementation Group being established
 Discussions with Hutt Valley / Wairarapa re opportunities relating to the 3-DHB
project
 Continuing development of local and regional MDMs
4.6 Indicative Costing
The following indicative costing is for investment required over and above DHB and CCN
investment. The region is seeking Ministry funding for 2012/13 to support the delivery of
this plan.
Item
Total Cost
FCT Project Manager (1.0FTE) (CCN to cover 0.5FTE)
Regional Cancer Data Analyst (0.3FTE)
FCT Trackers in CCDHB / MDHB (2 x 1.0FTE)
FCT Clinical Advisors in CCDHB / MDHB (2 x 0.4FTE)
$50,000
$30,000
$160,000
$70,000
Regional Data Consolidation tool / process (estimate)
$25,000
$335,000


Personnel costs are all inclusive per annum costs and would cover the period Nov
2012 – Nov 2013. If the funding is not accruable into the 2013/14 financial year
the total amount will need to be adjusted.
Meeting costs for the FCT Steering Group will be covered within the CCN meeting
budget
Funding arrangements from 2013/14:
 CCN will cover the full cost of the FCT Project Manager role
 CCN will cover the costs of the Regional Cancer Data Analyst as part of its
analytical services contract with Central TAS.
 MDHB / CCDHB will assess the need to continue to fund the FCT Tracker and FCT
Clinical Advisor roles depending on the status of the project.
4.7 Risk Management
To keep the project’s exposure to risk at an acceptable level, risks will be constantly
monitored, and appropriate and timely action implemented.
Implementation of risk management will be assessed at steering group meetings. Risk
owners will provide an update to the project manager, who in turn, will update the Risk
Register prior to the steering group papers going out.
The following risk areas have been identified to date and will be developed further as the
risk plan is completed:
 Clinicians across the region do not engage with the FCT indicators process
 DHBs utilise different proxies for certain data elements resulting in variable
reporting DHB management is not engaged with the FCT indicators
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CCN Faster Cancer Treatment Regional Implementation Plan – final





Communication about FCT activity needs to be managed to ensure Consumer
expectations are not raised prematurely
CT/MRI access criteria (6 weeks for urgent patients) does not enable DHBs to
meet the FCT indicators
FTE caps in DHBs impact on the ability to implement FCT roles
Funding for this plan is not met by the Ministry
Agreed regional data consolidation tool/process costs exceed budget
4.8 Assumptions, Dependencies and Constraints
Collection of the indicators will depend on the recommended personnel and ICT solution.
It is assumed that funding is available to enable this.
In the longer term this plan is dependant on the timely delivery of the CRISP solution.
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Appendix A:
____________ DHB Faster Cancer Treatment Implementation Group
DRAFT Terms of Reference
1. Purpose
This document describes the terms of reference, and membership for the Faster Cancer
Treatment (FCT) Implementation Group.
2. Background
The MOH signalled the FCT programme of work to DHBs and cancer networks in October
2011. The Minister of Health has agreed to the establishment of three indicators,
collectively referred to as the faster cancer treatment indicators. They are:

62 day indicator: all patients referred urgently with a high suspicion of cancer
receive their first cancer treatment (or other management) within 62 days

14 day indicator: all patients referred urgently with a high suspicion of cancer
have their first specialist assessment within 14 days

31 day indicator: all patients with a confirmed diagnosis of cancer receive
their first cancer treatment such as surgery, or other management such as
palliative care within 31 days of decision-to-treat.
The following outlines the indicative phased implementation approach:

2012/13: baseline data collection

2013/14: performance against 14 and 31 day indicator

2014/15: performance against 62 day indicator
The initial projects identified under this programme of work which are being led by the
regional cancer networks are:

the development of eight tumour stream standards by 30 June 2013

Regional faster cancer treatment implementation plans by 30 June 2012, noting
that plans must be flexible to adapt to the dynamic environment

Care coordination stocktake by 30 June 2012
A regional FCT Steering group has been established to guide and monitor this
programme of work.
3.



Role of the FCT Implementation Group
To coordinate, support and inform the FCT programme of work at the DHB level
To guide individual projects to successful implementation.
To advise on issues as they arise
4. Membership
Membership to include:
 Decision Support Unit
 ICT
 Managers – cancer and surgical
 Clinicians – cancer and surgical
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CCN Faster Cancer Treatment Regional Implementation Plan – final

Administrators – cancer and surgical
5. Meetings
To be scheduled as required
6.


Chair
Organise and Chair meetings as required
Communicate with CCN as required

Reporting
The DHB FCT Implementation Group will report to the (local cancer network)
7.
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CCN Faster Cancer Treatment Regional Implementation Plan – final
Appendix B:
CCN Faster Cancer Treatment Steering Group
Draft Terms of Reference
Purpose
The purpose of the Faster Cancer Treatment Steering Group is to:

develop and drive the implementation of the regional work plan for the faster cancer
treatment programme

provide leadership at regional level

report on implementation progress.
Background
The MOH signalled the FCT programme of work to DHBs and cancer networks in October
2011. The Minister of Health has agreed to the establishment of three indicators,
collectively referred to as the faster cancer treatment indicators. They are:

62 day indicator: all patients referred urgently with a high suspicion of cancer
receive their first cancer treatment (or other management) within 62 days

14 day indicator: all patients referred urgently with a high suspicion of cancer
have their first specialist assessment within 14 days

31 day indicator: all patients with a confirmed diagnosis of cancer receive
their first cancer treatment such as surgery, or other management such as
palliative care within 31 days of decision-to-treat.
The following outlines the indicative phased implementation approach:

2012/13: baseline data collection

2013/14: performance against 14 and 31 day indicator

2014/15: performance against 62 day indicator
Project Governance
The CCN Governance Group provides governance for the regional cancer control work
programme.
The Faster Cancer Treatment Steering Group will be a time limited subgroup of the CCN
Governance Group.
Delegations and Reporting
The Faster Cancer Treatment Steering Group will provide its recommendations to the
CCN Governance Group for final approval.
The Faster Cancer Treatment Steering Group will also provide regular updates to wider
stakeholders via regular programme reporting.
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Appointment Process
The Faster Cancer Treatment Steering Group will comprise a focused group of
individuals who will oversee the bringing together of an appropriate range of relevant
experience in relation to the implementation of the faster cancer treatment work
programme.
The CCN Governance Group Chair will appoint the members of the Faster Cancer
Treatment Steering Group. Following the resignation of any members during the term
of the Faster Cancer Treatment Steering Group, replacements will be made by the same
appointment process.
Membership of the Faster Cancer Treatment Steering Group will be initially for one year
with the option of reappointment for a further year or until the member chooses to step
down (whichever is the lesser term).
If a member is absent from three consecutive meetings that member can be removed
and another can be appointed in their place.
Chairperson
The chairperson of the Faster Cancer Treatment Steering Group will be appointed by the
CCN Governance Group Chair once members have been confirmed. The chairperson will
hold office for a one year term or until the member chooses to step down (whichever is
the lesser term). However, the chairperson may be appointed for a second term if
agreed by the group and the CCN Governance Group Chair.
Membership
Membership will include the following representation:












Chief Operating Officer (COOs to nominate)
GM Planning and Support (GMs to nominate)
CRISP representative
Chief Medical Officers (CMOs to nominate)
Clinical Director CCN
Regional Cancer Nurse Director CCN
CCN Network Manager
Decision Support Unit representative
DHB Cancer Manager representative
Surgical Manager representative
Primary Care representative
Consumer representatives
Roles and Responsibilities
The roles and responsibilities of the chairperson and members of the Faster Cancer
Treatment Steering Group are listed below.
a) The chairperson will be responsible for:
 managing meeting processes
 convening individual work streams as required
 reporting to the CCN Governance Group.
b) Members will be responsible for:
 participating and contributing to the Faster Cancer Treatment Steering
Group meetings
 providing input and expert advice as appropriate
 engaging with their peer groups as required.
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Work Streams
The Faster Cancer Treatment Steering Group has the ability to form sub-groups for
specific tasks and co-opt people with specific expertise to these sub-groups.
Terms of Reference Review
The Faster Cancer Treatment Steering Group terms of reference will be reviewed
annually.
Meetings
The Faster Cancer Treatment Steering Group will meet in May 2012 and then as
required.
Funding
The Faster Cancer Treatment Steering Group is not a fund holding organisation.
Support
CCN will provide project support to the Faster Cancer Treatment Steering Group
including arranging the meetings, and the distribution of agendas and minutes.
Travel and time will be funded through the representative’s employer for DHB
employees. CCN will fund travel and appropriate costs for people not employed by DHBs
as per the network’s payment policy.
Communication
A communication plan will be developed and maintained to ensure that there is
appropriate and timely communication to stakeholders.
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