1. Treatment Summary University of California San Francisco Center of Excellence for Breast Cancer Care PI: Laura J Esserman MD MBA; Edward Mahoney; Elly Cohen PhD; Susil Rayamajhi MS A Collaborative Tool for Generating a Care Plan and Treatment Summary This work is licensed under a Creative Commons Attribution 3.0 Unported License.Creative Commons Attribution 3.0 Unported License © 2007 Laura J Esserman

2. Improving Quality of Care UCSF Roadmap Strategy Z Patient Entered Data Intake, Sx, Follow-up MD Pt Collaborative Space Care Plans MD/ EMR Entered Data Pathology Treatment Data Central Data Repository Personal Health Record (Treatment Summary) Clinical Trial Matching caMATCH/ BCT.org Decision Aids Portals Research Aggregated Data for QI

3. Treatment Summary: The Need Patients need to know their treatment options when they are diagnosed with cancer Need to visualize treatment strategies and time lines Need to be able to share potential care plans with Family Other physicians Patients need a record of their care plan and where they are on the treatment continuum Indicate when complications affect time line Everyone needs structured treatment summary data Patients, providers, researchers, policymakers, registries, payers Enter once (correctly), use many times Patients should have access to clinical trials, decision support even if MD does not provide it

4. Treatment Summary: Design - form follows function Functional tool for use at the point of care Provide a space for patient/physician collaboration Provide context for the many physicians and caregivers that are involved with treatment Generate a care plan collaboratively As the care plan is carried out, the critical data (treatment summary) is generated as a by-product of care Maximizes interactivity with other useful applications, decision support, and outcomes of care

5. Treatment Summary: Step 1 MD/Patient create care plan during consultation Care Plan/ Calendar Situation 1. Example for 36 yr old with Stage 3b Her-2 positive, ER + breast CA 2. Example for 65 yr old with Stage 2a Her-2 negative ER + breast CA Surgery XRTChemoBiologicsHormonal Choices 2006 Jan April July Sept Chemo XRT Biologics Surgery + Hormonal 2006 Jan April July Sept SurgeryXRT Hormonal

6. Treatment Summary: Step 2 MD updates Care Plan with patient at each visit Surgery XRT Chemo Follow-up 2006 Jan Feb July Sept 2006-2010 Chemo Care Plan/Calendar Situation: Stage 2a breast cancer ER/PR/Her-2 negative, recurrence 4yrs post Rx

7. Treatment Summary: Embedded within Longitudinal Patient History

8. Treatment Summary: Component of UCSF Roadmap Scope Comprehensive patient data available at the point of care Facilitate patient/care provider collaboration Real-time collaboration supporting effective decision support Accessible via static devices and mobile technology (Smartphones, etc.) Scalable solution Open source Enterprise architecture Interoperability with new and existing healthcare solutions Support for healthcare and technical standards Continuity of care record (CCR/CCD) HL7 standards Templates and archetypes Unified medical language system (UMLS) Java 5, Ajax and business process execution language, etc.

9. Treatment Summary: Underlying Architecture Document Store Index Service Layer Presentation Layer Data Mapping 1. Data Input and Export 2. Document Storage 3. Document Indexing 4. Invoking Rules, Workflow and Normalization Input or View Input or Export Common Framework Common application design and development Semantically interoperable archetypes Leverage collaborative development Establish interoperable applications

10. Consumer Other Providers Pharmacy Clinician Monitoring Clinical Trials Disease Information Wellness Email and Calendaring Other Providers Pharmacy Consumer Diagnostics Clinical Trials Protocols Medical Search Email and Calendaring Drug Alerts Eligibility Clinician Treatment Summary: Exported to PHR/EMR and Available for Sharing Common Consumer and Clinician Requirements Single point of access to information collated from multiple sources Integration with existing healthcare applications Consumer privacy and confidentially Enhanced user experience Alerts and reminders Diagnostics