California Health eQuality Project Summary

Inspire Athena

January 2014

PROJECT NAME

Integrating Public Health and Clinical Data Exchange – INSPIRE

PROBLEM

The integration of clinical care and research systems is the key to the transformation of our industry. Project INSPIRE aims to identify a process for enabling real-time collection of key data elements on cancer patients by clinicians at the point of care, and develop the technology to certify and propagate this information downstream to researchers and disease registries and vice versa. Cancer in general, and breast cancer in particular, represents a specific high-impact condition of interest to public health and clinicians alike, and therefore was selected as the use case for exploration in this initial phase of the INSPIRE project.

SOLUTION

The Athena Breast Health Network is the demonstration venue for this project which developed a set of tools for physician data capture at the point of care. The first critical step was to understand the clinician workflow and to design a way to simplify data collection that aligned with clinician needs and workflow. As such, the Project INSPIRE team visited each UC Medical Center within the Athena network to investigate clinician workflows and systems to help identify opportunities for structured data capture and integration. Four UC sites participated in over 45 key informant interviews with clinicians, practice managers, cancer registrars, and other stakeholders to map current processes and opportunities. Specifically, the project team focused on handoff and interfaces between clinical workflows and data capture/validation/utilization through existing Health Information Exchange mechanisms or any internal systems. The workflow analysis identified over 350 barriers in the clinical data workflow process, and emerged a solution to create useful, actionable data between research and care by developing disease-specific, standardized data checklists. Integrated checklists are a method of obtaining key decision relevant at critical points in the care of a patient (pre-chemotherapy, pre-surgery, etc). This data can then be used downstream in dozens of other ways – central data repositories, clinical treatment summaries, registry reporting, etc. without need for re-validation. One critical transformation is the clinician’s role in reporting data so that clinicians are responsible for entering and verifying key data elements, which they will ‘own’ and enter data per their specialty into these checklists.

Checklists were developed and vetted by the Athena network clinicians, and align with the ASCO Treatment Summary and Survivorship Care Plan elements. The end result is managed data exchange by standards that enable electronically transmitted data to be sent and reconstituted using a standard known as a Continuity of Care Document (CCD) in the form of a ‘checklist’.

RATIONALE FOR SOLUTION

Rather than rely on separate work force to extract data, clinicians need to develop the discipline and the tools to help us capture the important data as a routine of care. In return, clinicians and researchers will get real-time, quality data that can be used for clinical decision making and registry reporting.

This project promotes an XML-based mechanism for checklists that any vendor can implement into their system to collect and certify the structured data once at the point of care. The XML-based approach is ubiquitous, widely supported through programming libraries, and has validation, which allows for the implementation of a specific XML schema straightforward. This has been demonstrated as such with the Clinical Data Architecture (CDA) standard, CCD, and College of American Pathologists electronic Cancer Checklists (CAP eCC). Compliance with this standard can be enforced using a well-established network- IHE (Integrating the Health Care Enterprise), an organization that has worked across all industry vendors to certify that they can accept data in the CCD format and to place it in critical places where clinical summaries can be seen “at a glance”.

Structured data packaged and shared through health information exchange (HIE) standards and adopted by industries across the board has tremendous value to clinical care and public health registries. Project leaders worked with members of the California Cancer Registry at the local, regional and state levels, as well as professional societies and standards bodies in the U.S. to help promote the standard, and to integrate these standards into meaningful use of electronic health records (EHRs).

OUTCOME AND NEXT STEPS

The next step is to seek funding to implement the developed Athena-INSPIRE clinician checklists across the Athena network (5 UC campuses and X Sanford hospitals/clinics)

·  Develop a strategy to implement the concept of the Health Information Home as a non-profit venture in California to support a longitudinal health record for breast cancer patients.

·  Continue collaborations with ASCO, HL7, College of American Pathologists, UC Davis IPHI, and the California Cancer Registry in advancing innovative approaches to data capture and data exchange.

The NCQA (National Center for Quality Assurance) should be engaged in this endeavor so that they can work to improve the quality measures that can be used nationwide as part of the Health Effectiveness Data and Information Set (HEDIS) measures for health plans across the country. At the point that the schema has been validated and demonstrated successful integrations, it should be promoted as an industry standard.

BENEFIT

This project advanced our understanding of direct data capture from clinicians at the point of care to support a cancer registry

·  Validating a new standard in data exchange for summary treatment information in cancer care. Vetted CDA standard

·  Uncovered inefficiencies through a workflow process map that are important in re-engineering the process