1. An Oncology Patient’s Journey from Treatment to Survivorship By Way of a Customized EMR
1/29/16

2. Facility Overview

3. Comprehensive Cancer Center at Desert Regional Medical Center
Fully integrated hospital-based ambulatory oncology care center
Satellite facility 20 miles away in La Quinta, CA
Onsite services – one stop shop for outpatient cancer care
Clinics
Treatment/Infusion Area
Laboratory
Pharmacy
Imaging
Oncology Supportive Care Services
Comprehensive Breast Center 3

4. Comprehensive Cancer Center at Desert Regional Medical Center
39,782 visits in 2014 (both campuses)
Snowbirds during winter
Monthly recurring accounts
Currently on Sunrise Ambulatory Care / Sunrise Pharmacy v15.1, CU6
Hospital uses a different EMR

5. Sunrise Modules Used Orders eMAR Clinical Documentation / Flowsheets
Patient education log / InfoButton
Rx Writer / e-Prescribe
Cancer Staging
Charging - Pharmacy, Nursing, Ancillary Services
Inbox / Secure Health Messaging
Sunrise Pharmacy
Nicole
-used a phase approach from physician practice to practice
-all clinicians except MD’s chart electronically now 5

6. Sunrise Modules Used Media link to scanned documents
Custom Oncology Viewer tab
Custom Picture Viewer tab
Custom Problems List tab
Custom Order/Results tab
Custom Research tab
Nicole
-used a phase approach from physician practice to practice
-all clinicians except MD’s chart electronically now 6

7. Custom Oncology Viewer & Radiation Treatment Integration

8. Efficient Treatment Monitoring
Paper flowsheets have long been used in Oncology to monitor a patient’s response to treatment
This format was used to develop the Oncology Viewer in SAC
Clinical summary does not display data in flowsheet format
Allscripts Clinical Data Viewer was not available
No need for data entry – data is available in SAC and aggregated for clinicians to quickly and easily find information
Viewed by users in many roles across the Cancer Center
3 parts to the Oncology Viewer – allows monitoring across all treatments
Main tab
Orders on Hold tab
Radiation tab

15. Treatment Not Administered

16. Select link to view scanned document
Scanned Document/Result Link
Select link to view scanned document

17. Transplant Days Counter

18. Future Chemotherapy Orders

19. Radiation Treatment
Data is sorted chronologically by Most Recent Treatment Date (left to right)

20. Radiation Treatment Data
Radiation treatment Result by Order pull sets now populate in Rad Onc Weekly Physician Progress Notes

21. Radiation Treatment Data
End of Treatment Summary & Survivorship Care Plan Report

22. Survivorship Care Plan Process

23. Purpose
IOM & National Research Council 2005 report From Cancer Patient to Cancer Survivors: Lost in Transition
“Too many survivors are lost in transition once they finish treatment…”
“Every cancer survivor should have a comprehensive care summary and follow-up plan once they complete their primary cancer care that reflects their treatment and addresses a myriad of post-treatment needs to improve their health and quality of life”
Meet Commission on Cancer’s Cancer Program Standard 3.3 by 2015

24. STANDARD 3.3 - Survivorship Care Plan
The cancer committee develops and implements a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee and documented in minutes.

25. Workflow
Clinic RN facilitates identification of patients who have completed active treatment
SCP order entered on Hold status

26. Workflow
RN initiates Follow Up Care Plan document and saves as incomplete
RN finalizes document in collaboration with the physician

27. Follow-Up Care Plan Document

28. Follow-Up Care Plan Document

29. Follow-Up Care Plan Document

30. Workflow
RN previews Survivorship Care Plan (SCP) Report for completeness
Follow-up with respective providers to complete data entry (Cancer Staging, Research)

31. SCP Report Sections Cancer Diagnosis Treatment Administered
Radiation Treatment Administered
Surgical Procedures
Clinical Trials
Follow-Up Plan
Provider Contact Information

32. Cancer Diagnosis
Data pulled from Sunrise Cancer Staging Module

33. Treatment Administered
Treatment administered at Cancer Center
Includes chemo, oral chemo, hormone therapy, research, bisphosphonates
Does not include supportive meds, iron, premeds, growth factors, phlebotomy, endocrine/metabolic
Rx’s from Rx Writer
Antineoplastics
Hormones

34. Treatment Administered – Cancer Center

35. Treatment Administered – Prescriptions

36. Radiation Treatment Administered
Daily treatment data interfaced from Aria
Only data since 2/17/12 will display

37. Surgical Procedures Data comes from several surgery orders
Once orders complete, displays on report (specified data items)
Surgeon name
Procedure
Location performed

38. Surgical Procedures

39. Clinical Trials
Data comes from Research End of Trial Summary structured note
Completed by Research Associates

40. End of Trial Summary Note

41. Clinical Trials Section of Report

42. Follow-Up Care Plan
Data comes from Follow-Up Care Plan structured note
Completed by RN

43. Follow-Up Care Plan – Report Section

44. Follow-Up Care Plan – Report Section

45. Follow-Up Care Plan – Report Section

46. Follow-Up Care Plan – Report Section

47. Provider Contact Information
Active attending care providers on patient’s chart
Address, phone/fax #’s

48. Workflow
Once document and report are complete, RN releases and completes the order
RN notifies Medical Secretary that report is ready for distribution
Medical Secretary generates report and distributes to patient and referring/primary care providers
Medical Secretary documents this information in a free text note
Tracking report for teams/managers to monitor entire process

49. Tracking Report – Monitors Status of the SCP Order

50. Contact Information
Nicole Valdez, MPH, RD
Mickie Cason-Boehm, RPh

51. Questions?