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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 Version 0.4 1 CCN Faster Cancer Treatment Regional Implementation Plan – final Faster Cancer Treatment Central Region Implementation Plan 2012 / 2013 Version: Final v0.4 Version 0.4 2 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 Version 0.4 3 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 Version 0.4 4 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. Version 0.4 5 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 Version 0.4 6 CCN Faster Cancer Treatment Regional Implementation Plan – final 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 Version 0.4 7 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 Version 0.4 8 CCN Faster Cancer Treatment Regional Implementation Plan – final 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 Version 0.4 9 CCN Faster Cancer Treatment Regional Implementation Plan – final 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 Version 0.4 10 CCN Faster Cancer Treatment Regional Implementation Plan – final 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. Version 0.4 11 CCN Faster Cancer Treatment Regional Implementation Plan – final 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 Version 0.4 12 CCN Faster Cancer Treatment Regional Implementation Plan – final 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 Version 0.4 13 CCN Faster Cancer Treatment Regional Implementation Plan – final 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 Version 0.4 Current State 14 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) Version 0.4 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 15 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 Version 0.4 CCDHB / MDHB FCT Project Manager Measures / Milestones Role in place Functions in place Framework in place 16 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 Version 0.4 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 17 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 Version 0.4 18 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 Version 0.4 19 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. Version 0.4 20 CCN Faster Cancer Treatment Regional Implementation Plan – final 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 Version 0.4 21 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. Version 0.4 22 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. Version 0.4 23 CCN Faster Cancer Treatment Regional Implementation Plan – final 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. Version 0.4 24 CCN Faster Cancer Treatment Regional Implementation Plan – final 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. Version 0.4 25