Translating developed technology oncology platforms from other healthcare contexts to the Australian healthcare environment Prof. Nilmini Wickramasinghe A/Prof. Paul Cooper Dr Muhammad Nadeem Shuakat Ms Cassandra Schultz
Agenda Background What is an Benefits sought The study The Australian/Victorian context Socio-technical lens Initial findings Next steps 2
Incidence of cancer continues to impact the health system AIHW: In 2013-14 there were around 936,000 cancer-related hospitalisations - an increase of 44% from 2001 02, when there were around 649,000 cancer-related hospitalisations. Over the same period, the agestandardised cancer-related hospitalisation rate increased by 8.9% from 337 per 10,000 population to 367 per 10,000. The top five most common reasons for cancer-related hospitalisations accounted for 96% of all hospitalisations where the principal diagnosis was a cancer-related treatment or service. With aging population, cancer has stretched developed countries health care systems in terms of financial, manpower and staff required to look after and manage treatment for cancer patients. 3
How an OIS can help Managing treatment plans, dose planning, image based decision. Improving accuracy of treatment Accessing data from multiple sites, reducing paper based data, online image reviewing in 2D and 3D, transferring data to external sites. Giving access to patient for making appointments, getting knowledge about before and after treatments, joining support groups Reduction in cost by eliminating clerical staff, reducing paper/film usage, delays in results transfer and reduces patient waiting time Giving patients access to their treatment summary, disease specific knowledge related to side,-late effects, health monitoring and support services along with managing appointments and print or fill questionnaires or forms before appointment. 4
More rapid diagnosis and treatment eg linked systems Improved integrated care e.g. through shared records and collaborative working tools Improved efficiency eg through reduced clerical staff Lower costs e.g. through dashboards which give insights into expensive, possibly avoidable treatments Benefits sought for Oncology Platforms Improved quality of care eg by connecting electronic records to enable sharing of clinical data together with genomic data, registry data and patient self-reported data on a large scale. More appropriate and tailored therapeutic protocol to be developed for each patient Monitoring the progress of patients in their treatment, to enable more informed and improved decisions about patient care 5
Major functions of OIS Integration of radiation oncology, particle therapy and medical oncology patient data in a single database Accessibility of patient data for multi-disciplinary teams from multiple locations with second by second data update Seamless connectivity to any linear accelerator & treatment planning system Evaluation of diagnosis-specific data to compare acute responses to treatment and long-term clinical outcomes Development of disease-specific clinical protocols to facilitate a standard, consistent quality of care Monitoring radiation dose and reviewing treatment images to determine if plan changes are required Calculating medication doses for entire treatment based on pre-defined dosing rules specific for each pathway 6
What our study is aiming to examine Phase One of the project reports on a systematic literature review of three international platforms that have the potential to deliver high-value patient centred care to cancer patients in an Australian context and examines a range of factors including functionality, usability, and translation of such platforms to the Australian healthcare context. 7
The Australian/Victorian context - strategic intents of Digital Health (DHHS Vic) Source: DHHS (Vic) 8
The Victorian Digital Health Landscape (DHHS Vic) 9
Victorian Digital Health Guiding Principles Clinical engagement clinicians must be actively involved in championing health technologies, realising expected benefits and efficiencies. Information and analytics information should be available across the full, unified continuum of carers/researchers to enable demand management and personalised healthcare. Adherence to agreed standards and interoperability explicit adoption of greed standards facilitates information flow and advances interoperability and quality of technology solutions. Robust and transparent governance Value-for-money and Business-driven decision making should be made by and for business reasons rather than be driven by the technology. 10
National Strategic Principles Putting users at the centre Ensuring privacy and security Fostering agile collaboration Driving a culture of safety and quality Improving equity of access Leveraging existing assets and capabilities Judicious use of taxpayer money - ensure that investments are assessed on the basis of delivering the best health and care outcomes for all Australians. 11
Using Activity Theory to inform our comparison (the LENS): Enables the understanding of interactions between human activities and various work practices (Leont'ev) 12
Activity Theory Elements Element Subject Object Tool Area Oncologists & Nurses Cancer patients & Family Cancer Platform 13
Our Overall Comparative Lens Adherence to agreed Internationa and Australian standards and interoperability & leveraging existing assets and capabilities Clinician led and patient-centric: enabling high levels of clinical engagement, while being patient-centric. Putting users at the centre & fostering agile collaboration Robust privacy and security Information and analytics information needs to be available across the full, unified continuum of care and be available for research to enable demand management and personalised healthcare Value-for-money the selected digital technology solution must provide value for money Safety and Quality 14
OIS - Compared via the LENS System A System B System C Multiple therapies [AT: Tools and Division of Labour] Support for medical and radiation oncology (including proton therapy) Centralization of radiation oncology, particle therapy and medical oncology patient data in a single database Actionable oncology decision support tools leverage a multiinstitutional data set composed of demographic, clinical, genomic, treatment, and patient outcome data. Billing [AT: Rules] Billing & cancer registry Missed-procedure billing advisories Export billed items to your choice of HL7-compliant billing software Billing and other third-party systems Claims and billing data from financial systems Image management [AT: Tools] Comprehensive review of clinical images Optimized image-guided treatment techniques Review images remotely and send set-up instructions to the treatment machine Review dosimetric images for IMRT pre-treatment quality assurance Compare images using automatic, manual or fiducial marker-matching algorithms Attach images, files or patient photographs to documents Sophisticated image visualization & distribution 3D viewers: RTP, XVI, & iview GT integration, adding and synchronizing tools, 2D image registration, volume image viewing External image registration Stereoscopic & volume image registration Setup details, immobilization devices and reference images entered into treatment chart Present complex, personalized analytics on individual patients based on clinical, molecular, and other relevant data in a clinically actionable format 15
OIS - Compared via the LENS System A System B System C Clinician led and patient-centric (configurable, adaptable, suitable for co-design) strong workflow support [From Comparative lens] Appointment scheduling, review images remotely, customisable data collection forms and questionnaires Electronic patient management allows users to achieve a paperless, filmless working environment; treatment setup workflow management Configure CARE reports to contain personalized analytic content and historical patient content formatted to your institution s & clinician s specific needs Information and analytics [From Comparative lens] Pain scoring to identify trends Trend analysis Integration, aggregation & personalized analytics on highly complex, disparate, multi-institutional data sources Adherence to agreed standards and interoperability & leveraging existing assets and capabilities [From Comparative lens] Facilitates compliance with the Work Health and Safety (WHS) Act Seamless connectivity to virtually any linear accelerator & treatment planning system from any vendor, providing unmatched integration, freedom and flexibility 16
OIS - Compared via the LENS System A System B System C PBS - - - [AT: Rules] Robust privacy, security and data protection [From Comparative lens] Built-in EDI (electronic data interchange) for secure online claim submissions High Availability and Rapid Recovery Protection (HARRP) continuous data protection and ensures minimal data loss and immediate recovery Eliminate error-prone work through tight integration that enables the seamless transition of data between tools - Safety and Quality [From Comparative lens] Windows 2000 and 2003 Manual, barcode and biometric patient identification and verification options provide multilevel safety checkpoints low cost, minimal impact to your IT team, data and network security resulting in very fast time-to-value. Comparison of cost, complications, toxicity and practice [AT: community of practice] - - System C gives comparison of Cost, complications, toxicity and even between different practice centres or clinics. 17
Initial findings Importance of being easy to use for both clinicians and patients Need to be patient centred Need to fit Australian/Victorian healthcare system some unique aspects eg VMOs Integration with doctor office/consulting rooms Access to Portal in exchange of patient recovery /treatment protocols Need to support efficient and effective care delivery 18
Specific steps in Australian Suitability Adherence to standards that are specific to Australia, support for PBS and MBS etc ICD-10-AM, AMT3, eviq, TNM Staging, NCI Common Toxicity Criteria, NSW and Queensland Clinical Cancer Data Dictionary Australian Pharmaceutical Benefits Scheme and Medicare Schedule. 19
Phases of Research Mapping of system functionality and user needs (clinician and patient) and then gap analysis Expansion to include current Australian OIS Development of rubric for ensuring systems are fit for purpose in the Australian healthcare environment Assessment of the impact of these solutions to support and enable high value, patient centred care 20
Contact details: n.wickramasinghe@deakin.edu.au p.cooper@deakin.edu.au 21