Author: Mirjana Phillips
What Cancer Centers Need to Know about the Changing CoC Accreditation Standards
Areas of biggest impact:
Personnel/Services Resources and Patient Care Expectations
The Commission on Cancer recently released changes to its accreditation standards, a move that is expected to impact accredited facilities in the year 2020. It’s important that every cancer program administrator understands these changes, whether your facility is currently accredited or is considering pursuing accreditation in the next couple of years. As stated on the American College of Surgeons (ACS) webinar yesterday, the purpose of this update was to begin to align all of the ACS Quality Programs to ensure a common experience across the entire spectrum of care.
The OncoLens team of experts has poured over the new standards and put together a high-level comparison of some of the most significant changes that have been made. It is not our intention to provide guidance on how to modify your current operations to meet these guidelines, but to simply make you aware of them.
OncoLens has helped more than 2800 cancer care providers and staff dramatically reduce the amount of time and resources spent on attaining and/or maintaining CoC, NAPBC and NAPRC accreditation every year. We are currently in the process of incorporating these new requirements into our cancer treatment planning solution and many of the newly required data elements will be captured automatically in the OncoLens tumor board and survivorship care planning and reporting modules.
Most OncoLens customers have been able to cut accreditation report preparation time by 90%. Learn more about how OncoLens can help your cancer center adapt to the 2020 CoC accreditation standards by emailing us for more information at info@oncolens.com.
Impactful Changes
Changes across nine domains can be found in the updated CoC accreditation manual. For a detailed view of the changes, cancer center administrators are encouraged to visit the CoC 2020 Standards website. The key changes highlighted by the OncoLens team are listed below and are focused on Domain 4 (Personnel and Services Resources) and Domain 5 (Patient Care: Expectations and Protocols).
A review of some differences between CoC’s 2016 and 2020 standards
2016 1.1 Physician Credentials
All physicians involved in the evaluation and management of cancer patients, as well as those serving in a required physician position on the cancer committee must be one of the following:
• Board certified; or
• In the process of becoming board certified, and
• Demonstrate ongoing cancer-related education by earning 12 cancer-related continuing medical education (CME) hours each calendar year. A maximum of six of the 12 hours can be earned through educational activities offered by the facility; however, all 12 hours can be earned through educational activities that are external to the facility.
2020 4.1 Physician Credentials
Cancer patient management is conducted by a multidisciplinary team, including radiologists, pathologists, surgeons, radiation oncologists, and medical oncologists. All physicians involved in the evaluation and management of cancer patients must:
• Be American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) board certified (or the equivalent), or
• Demonstrate ongoing cancer-related education by earning 12 cancer-related Continuing Medical Education (CME) hours each calendar year
2016 2.2 Oncology Nursing Care
Annual nursing competency evaluation of oncology knowledge and skills is completed and documented according to organizational policy, is approved by the cancer committee, and is documented in the cancer committee minutes. Oncology nursing certification for all nurses providing oncology care is strongly encouraged. All nurses who administer chemotherapy to patients need documented certification of chemotherapy training for both in-patient and out-patient units.
2020 4.2 Oncology Nursing Credentials
All registered nurses and advanced practice nurses providing direct oncology care must demonstrate one of the following:
• Current cancer-specific certification in the nurse’s specialty by an accredited certification program, or
• Ongoing education by earning 36 cancer-related continuing education nursing contact hours each accreditation cycle
2016 1.11 Cancer Registry Education
And
2016 5.1 Cancer Registrar Credentials
Each calendar year, all members of the cancer registry staff participate in one cancer-related educational activity applicable to their role.
Case abstracting is performed by a Certified Tumor Registrar.
2020 4.3 Cancer Registry Staff Credentials
Each calendar year, members of the cancer registry staff who do not hold a CTR credential must demonstrate completion of three hours of cancer-related continuing education applicable to their roles.
2016 2.3 Genetic Counseling and Risk Assessment
Cancer risk assessment, genetic counseling, and genetic testing services are provided to patients either on-site or by referral to a qualified genetics professional.
The cancer committee will monitor, evaluate, and make recommendations for improvements, as needed, cancer risk assessment, genetic counseling, and genetic testing and/or referrals annually and document in the cancer committee minutes.
2020 4.4 Genetic Counseling and Risk Assessment
While it is expected that programs provide genetics assessment for all relevant cancers on an on-going basis, each calendar year programs must identify a process pursuant to evidence-based national guidelines for genetic assessment for a specific cancer site.
The cancer committee must review and document in the minutes:
• The number of patients identified as needing referrals for the selected cancer site each year, and
• How many patients identified as needing referrals for the selected cancer site received a referral for genetic counseling
It is encouraged, but not required, that programs track whether patients who received referrals ultimately had genetic counseling
2016 2.4 Palliative Care Services
Palliative care services are available to patients either on-site or by referral.
The cancer committee will monitor, evaluate, and make recommendations for improvements, as needed, to palliative care services and/or referrals annually and document in the cancer committee minutes.
2020 4.5 Palliative Care Services
Each calendar year, the cancer committee monitors, evaluates, and makes recommendations for improvements to palliative care services. The evaluation is documented in the cancer committee minutes. During this evaluation, the cancer committee must:
• Assess the approximate number of cancer patients referred for palliative care services and for what services or resources
• Discuss the criteria utilized to trigger referrals to palliative care services
• Discuss areas of improvement – Examples include, but are not limited to, barriers to access of palliative care services, addition of palliative care services, decreasing emergency department usage, or improving the timeliness of referrals.
2016 ER 11 Rehabilitation Services
Policies and procedures are in place to ensure patient access to rehabilitation services either on-site or by referral.
2020 4.6 Rehabilitation Care Services
Each calendar year, the cancer committee must monitor, evaluate, and make recommendations for improvements, as needed, to rehabilitation care services and/or referrals. The content of the review and any recommendations for improvement are documented in the cancer committee minutes.
2016 ER 12 Nutrition Services
Policies and procedures are in place to ensure patient access to nutrition services either on-site or by referral.
2020 4.7 Oncology Nutrition Services
Each calendar year, the cancer committee must monitor, evaluate, and make recommendations for improvements to on-site oncology nutrition and hydration services and/ or referral services. The content of the review and any recommendations for improvement are documented in the cancer committee minutes.
2016 3.3 Survivorship Care Plan
The cancer committee develops and implements a process to disseminate a treatment summary and follow-up plan to patients who have completed cancer treatment.
End of 2018 and on: Provide SCPs to 50 percent of eligible patients who have completed treatment.
2020 4.8 Survivorship Care Plan
The cancer committee appoints a coordinator of the survivorship program per the requirements in Standard 2.1: Cancer Committee.
The Survivorship Program Coordinator develops a survivorship program team. Suggested specialties include physicians, advanced practice providers, nurses, social workers, nutritionists, physical therapists, and other allied health professionals.
The survivorship program team determines a list of services and programs, offered on-site or by referral, that address the needs of cancer survivors. The team formally documents a minimum of three services offered each year. Services may be continued year to year, but it is expected that cancer programs will strive to enhance existing services over time and develop new services.
Each year, the survivorship program coordinator gives a report, and the cancer committee reviews the activities of the survivorship program. The report includes: • An estimate of the number of cancer patients who participated in the three identified services • Identification of the resources needed to improve the services if barriers were encountered
Programs must demonstrate compliance by 1/1/2021
2016 2.1 College of American Pathologists Protocols and Synoptic Reporting
Each calendar year, 95 percent of the eligible cancer pathology contain all required data elements of the College of American Pathologists (CAP) protocols and are structured using the synoptic reporting format as defined by the CAP Cancer Committee.
For CoC-accredited programs, the CAP protocols apply to the following:
• Pathology reports created by the program from resected specimens with a diagnosis of invasive cancer.
• Pathology reports created by the program from resected specimens with a diagnosis of ductal carcinoma in situ (DCIS). Diagnostic biopsy specimens, cytology specimens, special studies, and reports of carcinoma in situ (except for ductal carcinoma in situ) are excluded.
At a minimum, a random sample of 10 percent of pathology reports eligible for the CAP protocols or a maximum of 300 cases are reviewed each year to document compliance with this standard. The cancer committee may delegate the quality control activity to a pathologist who will report the quality control activity and a summary of the findings annually to the cancer committee.
2020 5.1 College of American Pathologists Synoptic Reporting
Ninety percent of the eligible cancer pathology reports are structured using synoptic reporting format as defined by the College of American Pathologists (CAP) cancer protocols, including containing all core data elements within the synoptic format.
For CoC-accredited programs, “eligible cancer pathology reports” are defined as: • Definitive surgical resection of primary invasive malignancies and ductal carcinoma in situ (DCIS), and • Definitive surgical resection in patients who have received neoadjuvant therapy AND who have residual tumor.
2016 3.2 Psychosocial Distress Screening and
2016 ER10 Psychosocial Services
Cancer programs must develop a process to incorporate the screening of distress into the standard care of oncology patients.
All cancer patients must be screened for distress a minimum of one time at a pivotal medical visit as determined by the program.
Policies and procedures are in place to ensure patient access to psychosocial services either on-site or by referral.
2020 5.2: Psychosocial Distress Screening
Psychosocial services are available on-site or by referral.
Cancer patients are screened for psychosocial distress at least once during the first course of treatment.
The following patients are not included in compliance for this standard:
• Biopsy only or class of case “00” patients
• Patients who are admitted to the hospital with a history of cancer, but for non-cancer related issues
• Inpatients with a current diagnosis of cancer who are treated for a non-cancer issue and do not receive cancer treatment
2016 N/A
Phase-in Standard
2020 5.3 Breast Sentinel Node Biopsy
All sentinel nodes for breast cancer are identified, removed, and subjected to pathologic analysis.
Operative reports for patients undergoing breast sentinel node biopsy includes required minimum elements in synoptic format.
2016 N/A
Phase-in Standard
2020 5.4 Breast Axillary Dissection
Axillary dissections for breast cancer remove level I and II lymph nodes within an anatomic triangle comprised of the axillary vein, chest wall, and latissimus dorsi, while preserving key neurovascular structures.
Operative reports for patients undergoing axillary dissection include the required minimum elements in synoptic format.
2016 N/A
Phase-in Standard
2020 5.5 Primary Cutaneous Melanoma
This standard applies to patients undergoing curative-intent wide local excision of a primary cutaneous melanoma lesion.
Clinical margin width for wide local excision of invasive melanoma is 1 cm for melanomas less than 1 mm thick.
Clinical margin width for wide local excision of invasive melanoma is 1 to 2 cm for melanomas 1 to 2 mm thick.
Clinical margin width for wide local excision of invasive melanoma is 2 cm for melanomas greater than 2 mm thick.
The clinical margin width for wide local excision of a melanoma in situ is at least 5 mm.
Operative reports for patients undergoing a wide local excision of a primary cutaneous melanoma include the required minimum elements in synoptic format.
2016 N/A
Phase-in Standard
2020 5.6 Colon Resection
This standard applies to all curative resections for colon cancer and applies to all operative approaches.
Resection of the tumor-bearing bowel segment and complete lymphadenectomy is performed en bloc with proximal vascular ligation at the origin of the primary feeding vessel(s).
Operative reports for patients undergoing resection for colon cancer include the required minimum elements in synoptic format.
2016 N/A
Phase-in Standard
2020 5.7 Total Mesorectal Excision
This standard applies to operations for curative intent radical resections of rectal adenocarcinoma and excludes local excision approaches.
Total mesorectal excision is performed for all patients undergoing radical surgical resection of mid and low rectal cancers and results in a complete or near complete mesorectal excision.
The quality of TME resection (complete, near complete, or incomplete) is documented in curative resection of rectal adenocarcinoma pathology reports in synoptic format.
2016 N/A
Phase-in Standard
2020 5.8 Pulmonary Resection
This standard applies to the primary surgical procedure for curative intent pulmonary resections for non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and carcinoid tumors of the lung. This standard applies to all operative approaches.
The surgical pathology report following any curative intent pulmonary resection for primary lung malignancy must contain lymph nodes from at least one (named and/ or numbered) hilar station and at least three distinct (named and/or numbered) mediastinal stations.
The nodal stations examined by the pathologist must be documented in curative pulmonary resection pathology reports in synoptic format
Phase-In Standards
There are several standards that will be phased in over the coming years. These standards are more clinical in nature, and therefore the CoC will give facilities more time to study these standards and work toward implementation over time. They mainly center around cancer surgeries for certain disease sites, oncology nursing credentials, and also survivorship care planning. Administrators are encouraged to work collaboratively with their surgeons and hospital staff to introduce these new standards at their facility and the ACS will continue to provide education sessions on the new requirements.
Next Steps
OncoLens is preparing a more comprehensive webinar for the industry and plans to discuss how its platform can assist cancer centers with CoC, NAPBC, and NAPRC accreditation. Registration will be opening soon so watch our blog and social media posts for notification of the date and time!
WellStar Health System Aligns with OncoLens in Pursuit of Multidisciplinary Care Efficiencies and NAPRC Accreditation
As one of the fastest growing health systems in Georgia, WellStar Health System offers patients a comprehensive network of hospitals (11), urgent care centers (15), and satellite imaging centers (16), plus nursing, hospice, and other healthcare facilities. The organization prides itself on adopting the latest innovations and delivering world-class patient care to the communities it services. Its cancer centers are no exception.
With 13 different recurring cancer conferences across the health system and a rapidly growing patient population, Leigh Webb, WellStar’s Cancer Data Quality and Accreditation Manager, found the amount of manual work involved in managing the tumor board conferences and accreditation reports overwhelming. She knew it was time to rethink the way the health system prepared for and conducted its multi-specialty conferences. That’s when she turned to OncoLens.
“We decided to deploy OncoLens in two of our centers that had the highest volume of cases. Our goal was to create a better experience for our physicians and care team members by streamlining the manual work required for tumor board conferences,” said Webb. “We also wanted to find a better way to minimize the volume of emails and phone calls that often came in during last minute preparations for our conference, and to facilitate more productive conferences. Our physicians and their assistants have found it to be so much easier because they are able to quickly enter the case directly into the application. Our administrative team is able to generate the necessary reports for accreditation instantly vs. having to enter mountains of data at the end of the year.”
The whole process is much more streamlined, and we are able to focus on the patient, not the paperwork
Out with the Old
Prior to implementing OncoLens, the WellStar team of physicians, oncologists, radiologists and others were dependent on emails and calls to schedule cases and gather the necessary patient information. The registrar team was constantly monitoring the email box and voicemail system to watch for case information. Plus, registrars spent days entering information into reports that had to be submitted to maintain Commission on Cancer (COC) accreditation. Everyone had to sift through thick binders of case information during the sessions.
With OncoLens, the system automatically schedules the conferences and notifies each participant of what information is needed and what has been submitted. Information can be easily uploaded into a centralized place that all participants can access anywhere, any time. As the conference occurs, smart forms are populated with the necessary data that creates a record of the conference and ensures the session supports the health system’s accreditation goals. The necessary reports can be generated with the click of a button.
According to Webb, “One of the best things about using the OncoLens platform to manage our tumor board conferences and accreditation efforts is the fact that everything sits in one place. Everyone knows exactly what needs to be done by when. They can easily upload their slides, and we don’t have to create PowerPoint presentations for every case. The whole process is much more streamlined, and we are able to focus on the patient, not the paperwork.”
By guiding the conferences along and making sure the appropriate clinical and operational processes are followed to be in compliance with accreditation requirements, Webb identified the opportunity to leverage the reports in OncoLens to pursue the new guidelines for accreditation under the National Accreditation Program for Rectal Cancer (NAPRC). NAPRC was developed through a collaboration of The OSTRiCh Consortium (Optimizing the Surgical Treatment of Rectal Cancer) and the CoC. With the goal of ensuring patients with rectal cancer receive appropriate care using a multi-disciplinary approach, it is more intense than its predecessor, National Accreditation Program for Breast Cancer (NAPBC). The requirements have a stronger emphasis on clinical data capture and multiple rounds of discussions at various stages along the treatment plan. The complexities are greater, and therefore can be perceived to be harder to manage.
“We worked closely with the OncoLens team to take the NAPRC guidelines and build business logic and reporting capabilities into the system that allows us to more easily follow the recommended steps and capture the clinical information we need to pursue NAPRC accreditation. Reports that used to take us days to prepare now can be done in minutes by clicking a button in OncoLens” added Webb.
Some of the added benefits that Webb and her team are starting to realize with the solution include the presentation of relevant clinical trials that the system generates based on the case type and makes available with the touch of a button during conferences.
White-Glove Customer Support
Having great technology isn’t always enough though. Technology must be backed by a strong customer support team. According to Webb, working with the OncoLens team has been great. “The OncoLens team was amazing, from the first interaction with the co-founders, Anju Mathew and Dr. Lijo Simpson, to the day-to-day customer success team, led by Ebony Johnson. They are very interactive and act on our suggestions, and they are proactive in being sure we have everything we need to successfully roll out the solution across our centers. You just can’t put a value on that,” she added.
The Future Looks Bright for WellStar
Under the constant pressure of providing high quality patient service and aligning with value-based care reimbursement models, WellStar is constantly looking for ways to improve efficiencies and deliver high quality care to their patients. With rectal cancer being one of the fastest growing types of cancer, achieving NAPRC accreditation across its facilities is a top priority. The organization wants to ensure the communities it serves know that they can come to WellStar and receive the highest quality care possible.
As the health system continues its strong track record of growth across the state of Georgia, Webb and her team expect to continue to benefit from the product plans OncoLens has in place. “We look forward to a long and highly productive partnership with the OncoLens team.”
About WellStar Health System
WellStar Health System, the largest health system in Georgia, is known nationally for its innovative care models, focused on improving quality and access to healthcare. Staying ahead of the curve in technology has enabled WellStar to be leaders in both the diagnosis and treatment of an extensive array of health conditions. Serving a diverse population, WellStar consistently looks at total patient wellness and works to ensure that all systems support that focus. WellStar is recognized nationally as an Employer of Choice and is featured on FORTUNE 100 Best Companies to Work For® list and Work Mother Magazine’s Best Companies list.
About OncoLens
OncoLens develops technologies that improve cancer treatment planning, simplify Tumor Board management, facilitate survivorship care planning, and automate accreditation and quality reporting through an intelligent workflow engine that streamlines business processes and enables more informed clinical decision-making. To learn more about OncoLens, please visit www.OncoLens.com
WellStar Health System at a Glance
- Main Offices: 805 Sandy Plains Road, Marietta, Georgia 30066
- Employees: 20,000+
- 11 hospitals, 15 urgent care centers
- 16 satellite diagnostic imaging centers
- 3 health parks, 1 pediatric center
- 1 adult congregate living facility
- 3 inpatient hospices, 3 skilled nursing facilities
- 225 medical office locations
How it Works
OncoLens uses an intuitive, rules-based engine that intelligently automates workflows to simplify and organize the cancer treatment planning process, helping cancer centers:
- coordinate and conduct Tumor Board conferences
- automatically create survivorship care plans and identify eligible patients
- capture accreditation data and quality metrics during conferences
- identify case-specific research and clinical opportunities
OncoLens removes many operational barriers, enabling cancer centers to discuss two to five more cases per Tumor Board; and facilitating a whole new level of collaboration, allowing more experts the opportunity to contribute their ideas. Most importantly, it gives patients the opportunity to receive the best possible care plan.
For more information, visit oncolens.com
© 2019 OncoLens, Inc.
Multidisciplinary Opinions (Tumor Boards) at the Center of the NAPRC
The National Accreditation Program for Rectal Cancer (NAPRC) is one of the American College of Surgeons Commission on Cancer’s newest quality improvement initiatives. The idea of the NAPRC stems greatly from the statistically proven fact that patients treated for rectal cancer in Europe have significantly better outcomes than those diagnosed and treated in the United States. The biggest difference between the care of rectal patients in Europe and the US is the standardized multidisciplinary team approach taken by care providers in Europe compared to the siloed approach that is more popular in the US.
In 2011 Cleveland Clinic’s Steven D. Wexner, MD, PhD(Hon), FACS, FRCS, FRCS(Ed), convened with several of his colleagues from across the country to develop the Optimizing the Surgical Treatment of Rectal Cancer (OSTRiCh) consortium. Their main objective was to study the reasons why rectal cancer outcomes in the US were so inferior to those in Europe. After realizing that it had much to do with standardization and multidisciplinary teamwork, they set out to create a set of standards that hospitals across the country could adopt and thus see the improvements in their patient’s lives much like what is being seen in Europe. These standards became known as the National Accreditation Program for Rectal Cancer.
Rectal cancer programs seeking the NAPRC accreditation must commit to having a rectal cancer Multidisciplinary Team (Tumor board) which would include representation from surgery, pathology, radiology, medical oncology, and radiation oncology. They are required to convene at a minimum of twice a month and a program coordinator must be designated to coordinate their activities. Treatment planning discussions are required that include diagnostic review, clinical staging assignments, and multidisciplinary input on the patient’s individualized treatment plan. After surgery, the operative report is required to be in a standardized synoptic format because checklists are credited for the substantial decrease in inpatient complications and perioperative mortality. Studies show that in fact, information in the form of synoptic reporting as compared to narrative reporting is typically more complete and more reliable. At the next tumor board meeting (outcome discussion), images of the patient’s surgical specimens are then shared with the multidisciplinary team and the team decides on a recommendation for adjuvant therapy.
OncoLens is a multidisciplinary care planning platform for every cancer patient but can specifically help hospitals to achieve and maintain NAPRC accreditation. OncoLens replaces the labor-intensive process of tumor board preparation by using easy to use, click-based templates to create case histories and automatically routing them to pathology, radiology, research teams, and physician members of a patient’s care team. In addition, the platform merges case specific clinical trial and decision support guidelines into the meeting presentation and assists with the monitoring and reporting of accreditation metrics. The use of OncoLens has been proven to improve the quality and time to treatment for cancer patients and evolves the tumor board experience for cancer programs nationwide.
New accreditation program for rectal cancer
Accreditation program offers path to improved rectal cancer outcomes
What Does Medicine’s Changing Demographic Mean for Healthcare Technology?
The millennial generation is now the largest component of the workforce. As more millennials begin their careers and Baby Boomers continue to retire, the generational picture is changing. This change extends to medicine as well. As the demographics change, so will the attitude of doctors toward technology. According to American Medical Association data, 15% of the total number of physicians is under age 35. Other organizations confirm this statistical trend. Approximately 25% of the American Academy of Family Physician’s active membership is age 39 or younger. Twenty-five percent of the American Osteopathic Association’s membership is 35 or younger. With the shift in demographics of the workforce, the way workers complete their tasks is changing.
How does this generational shift affect healthcare? Millennials are the considered the first digital natives. Born between 1981 and 2000, they have grown up surrounded by technology. This experience creates an expectation to integrate technology into the workplace. Millennials differ from previous generations in their approach to healthcare, seeking to educate themselves from multiple sources. These differences extend to doctors as well. While older doctors are resistant to technology, including Electronic Health Records (EHR), millennial physicians acknowledge that EHRs are an asset to providing quality patient care. Millennial physicians also are more data-driven, looking to evidence-based medicine to direct their patient care decisions. Younger physicians are more receptive to looking up information during patient encounters, using their phones or built-in plugins in the EHR.
Younger physicians are more likely to incorporate newer forms of technology into their practice. Social media use is more likely with younger physicians. Twitter is popular as both an information source and as a way to distribute information. Younger doctors are willing to collaborate over social media.
The use of technology extends to the actual practice of medicine. The traditional office visit is being transformed with the implantation of telemedicine. A 2018 survey of physicians reports that 18.5% of physicians practice some sort of telemedicine. Telemedicine visits can be used to provide primary care to patients or to bring specialized healthcare to underserved areas and populations. The use of telemedicine is project to rise as 60% of millennials support the use of telehealth options.
The acceptance of technology by all physicians will be a prerequisite to the future of healthcare. Patients will also drive the inclusion of technology into healthcare. Salesforce’s 2015 survey of the State of the Connected Patient shows:
- 50% of millennials are interested in cutting edge devices as part of their health experience.
- Over 60% are interested in wearables.
- More than 70% of millennials are interested in using their mobile devices and mobile apps as part of their healthcare experience.
- 71% would like their doctor to use a mobile app
Technology has the opportunity to assist physicians in providing relevant and up-to-date care. The current average hours worked for physicians is 51.4 hours per week. Of those 51.4 hours, 11.37 of them are using for completing paperwork. Leveraging the power of technology could give some of those hours back to the physician. Automating workflows and creating standard order sets and treatment plans would allow physicians to easily incorporate new scientific discoveries across all patients along with saving time.
For those physicians and healthcare staff working in oncology, the administrative burden is large. Adhering to accreditation standards and participating in cancer care conferences requires coordination of large amounts of information. Employing a platform that allows all participants of the tumor board conference to interact in real time and incorporates the ability to connect remotely from a smart phone can decrease the time involved. By simplifying the process and creating an environment for collaboration, technology facilitates improved care for patients. A recent case study showed how one hospital decreased tumor board preparation time from 10 hours per meeting to only one hour. This benefit extends to the entire team, not only physicians. Using a platform such as OncoLens, tumor board members have the ability to enter information from their smart phone and access the information that others have provided. Providing the ability to attend tumor conferences remotely by using the app, OncoLens increases the collaborative environment. OncoLens has the ability to integrate into existing EHRs or collate information from different systems and locations. The platform documents treatment discussions, provides current treatment protocols, screens for clinical trials, and incorporates survivorship care plans and provides access to this information for all care team members. All functions are Health Insurance Portability and Accountability Act (HIPAA) compliant, safeguarding private health information (PHI) of all patients.
All of the medical community will need to become involved in these technologies to remain relevant as our demographics change. The continued introduction of technology into the healthcare space will transform the provision of healthcare, resulting in better and more efficient care for all.
Going Beyond the Tumor Board Experience
BACKGROUND
The St. Tammany Cancer Center opened its doors in 2012, consolidating for our community radiation and medical oncology services, diagnostic imaging, infusion and lab all in one location. Since that time, we have implemented:
- Two physician driven multidisciplinary teams designed to improve the care of patients with breast and lung cancers.
- Endobronchial ultrasound (EBUS) and Endoscopic ultrasound (EUS), making us a regional destination for these procedures.
- Addition of a monthly multidisciplinary GI conference in mid-2016.
- NAPBC accreditation in 2017 with resulting biweekly multidisciplinary breast conferences.
Our hospital has seen tremendous growth in our cancer program with a 30% growth in new cancer cases between 2012 and 2017. With continued American College of Surgeons Commission on Cancer (CoC) accreditation, we found ourselves with five conferences being held on a monthly basis. As with many hospitals, we also found ourselves with Registry staff being moved offsite to allow for expansion of services critical to patient care within the hospital itself. With the growth of our Registry volume and the addition of conferences, we found our registry staff being stretched to limits not seen before.
PROCESS
We estimated that it was taking close to 10 hours per conference to ensure conferences were a success. Many of the steps were repetitive to ensure that appropriate pathology and imaging was available for review and that the documentation requirements needed for both CoC and NAPBC accreditation were met. Much of that documentation was manual and a duplication of efforts:
- Cases were emailed to the conference coordinator by the physicians presenting.
- Folders with each case, the pathology reports, and documentation of images needed for cases had to be brought to the hospital’s Pathology and Radiology Departments; additional cases added on required additional trips to bring documentation to Pathology and Radiology at the main campus.
- Case documentation as well as items discussed and attendance were documented at the conference and again after the conference to enable required documentation for accreditation purposes to be on a spreadsheet for each conference after the conference was completed.
Our facility has had numerous conversations over the years about including conference documentation in the EMR. Physicians and our legal departments had concerns regarding this procedure as the documentation is discoverable. We have a number of facilities participating in conferences, many of them with separate EMR systems so the conference discussions would not be part of all EMR programs. We meet at the most, every other week so this concerned our medical staff. One diagnostic exam can change the course of treatment for a patient; no one wanted to have documentation of treatment planning in the record and not have timely follow-up as to why treatment changes might have occurred, whether stage or patient driven.We were fortunate to meet Dr. Lijo Simpson, Medical Oncology, at a cancer conference in 2017 and got a chance to learn about the program he and his team had developed to manage conferences. As a member of the Cancer Committee at various facilities, he saw the amount of time it was taking Registry staff to complete just one conference and his experience was similar to mine. In late 2017, we had the developers of OncoLens do a webinar for our Registry staff and ended up having a second webinar to include our Cancer Program Administrator.
OncoLens is a web and phone based HIPAA compliant platform that facilitates quality care treatment planning at cancer programs through improved workflows, clinical decision support and customizable reporting. What impressed us all is how comprehensive the software is.
- Physicians or their staff can enter their own cases putting in the required minimal documentation, but also having the ability to ask Pathology or Radiology a specific question they want to review at the conference. The platform is also capable of integrating into EMRs.
- Departments such as Pathology or Radiology as well as the Registry staff and our clinical trials nurse, are notified when a case is added; this can be modified to receive information weekly or as needed, but our staff has enjoyed the notification whenever a case is added.
“What impressed us all is how comprehensive the software is.”
- Pathology and Radiology can add pictures to the actual case presentation so when the application is started, the patient history is present as well as the pdf of the path report, the pathology images, and radiology images. We have not progressed to uploading Radiology images at this point at the radiologists preference, but that has not presented an issue.
- Clinical trial information within a 50 mile radius shows up if the patient seems to meet criteria for study entry; this keeps clinical trials on the forefront of physicians’ minds when treatment planning. As we strive for commendation levels for clinical trial accrual each year, this was a huge aspect in our Cancer Program Administrator’s eyes.
- You can email securely members of the care team and coordinate follow up care directly from the platform.
- Documentation needed for conferences occurs real time, attendance, items discussed (such as NCCN guidelines, stage, genetics, was the case prospective) can all be done at the conference, not the day after.
- The platform is HIPAA compliant and PHI is visible only to the members of the care team and completely de-identified during the tumor board presentation.
- Discussions can be documented regarding the case, questions, treatment decisions.
- The templates are customizable to include any relevant quality metrics at the cancer program that you wish to bring up during tumor board for ongoing provider education or reminders.
- Reports can be run on anything you need, attendance, number of cases discussed, what aspects were discussed, number of conferences, number of prospective discussions.
IMPLEMENTATION
Once we decided to move forward with implementation, the company was wonderful in providing a timeline. This included:
- Administrator training – Registry staff and personnel like me who need to run reports and document at the conference.
- Provision of a list of all physicians and allied health who needed access to not only load cases, but to be able to review cases and add input. We made sure to include staff at the physician offices who we knew added cases for physicians.
- Provision of all the conference dates of the year that the OncoLens staff loaded so when posting a case, the physician has access to the dates of the conference he/she wants to do their presentation.
- All with OncoLens access were provided with a welcome email including their login credentials they could then change; included was a short video on how to post a case.
- Pathology and Radiology received their own emails with a short video on how to upload images.
- We defined an implementation date. At conferences prior to the implementation date, we discussed OncoLens and even had Dr. Simpson and the President of OncoLens do a short 10 minute presentation on the program, advantages and how to load cases/upload images at several of our conferences.
- We went live!
We implemented OncoLens mid-April exclusively as our conference platform for case requests and presentation and documentation of required elements from our June 13, 2018 conference on and the results have been amazing.
“95% of our physicians use their Smart Phones to upload their own cases or have their staff post cases.”
- Ninety five percent of our physicians use their Smart Phones to upload their own cases or have their staff post cases. The application is on their phone so they can see a patient and enter the information. Imagine you are a physician having just completed an EUS procedure and knowing you have a new pancreatic case, taking out your phone and uploading the case while fresh on your mind. That is the experience we are seeing.
- The agenda is created automatically in OncoLens using the information entered by physicians and/or Registry staff who often supplement patient history as they are researching the case.
- I have been able to run reports to monitor physician attendance by specialty, to look at our conference presentation volume over past years (it has increased), and other measures. Come December, I will be able to run a report to provide to our CoC and NAPBC meetings on the required elements of conference presentations.
- If a member of the care team is not present we can email them the recommendations (with only the patient initials visible) from the platform – e.g. the patient needs a PET scan before starting treatment or a liver biopsy may be indicated to validate the presence of a suspicious lesion in the liver. One of my favorite stories is having a surgeon present a breast cancer case where the patient was having difficulty with copays for all their appointments and he need the social worker/patient financial counselor to intervene. I was able to document the conversation in OncoLens and email it to our social worker at the cancer center who was able to follow-up with the patient the next day to work with her on resolving her financial concerns.
- Pathologists love to use their phones to take pictures needed for case presentations.
- Clinical trials and genetics are spoken of more often as is clinical staging.
- Most of all, the time taken for a single conference has decreased to around 1 hour from the original 10 hours pre-and post-conference allowing my Registry staff personnel to perform more vital Registry functions. Much of this one hour is not in OncoLens, but in initiating abstracts for the cases to be presented.
“We noted an uptick in the number of cases being placed on the conference schedules which we honestly attribute to the use of OncoLens.”
The support, initial and ongoing, we have received from the company has made this experience even more delightful. Questions are answered expediently, whether it is from hospital staff or physicians.
Recently, we noted an uptick in the number of cases being placed on the conference schedules which we honestly attribute to the use of OncoLens. We requested that whomever was posting the case be able to have a place to document whether the case was high, medium or low priority (versus utilizing the urgent or not urgent flag on the system), something our physicians have been used to submitting. That consideration is in development by the company at this time.
St. Tammany Parish Hospital’s commitment to deliver worldclass healthcare close to home and our partnerships with Mary Bird Perkins Cancer Center and Ochsner Health System combine to elevate the level of care available in St. Tammany Cancer Center. St. Tammany Parish Hospital hosting these two trusted providers continues the center’s commitment for world-class cancer care close to home.
Services available through St. Tammany Cancer Center include radiation therapy, chemotherapy, PET CT imaging, clinical research trials, nurse navigation patient support services, community screenings and education. The center’s multidisciplinary approach includes surgeons, medical oncologists, radiation oncologists, pathologists, radiologists and other specialists building upon the center’s proven highly personalized approach to patient care.
Since 1998, St. Tammany Parish Hospital has collaborated with MBPCC to deliver the full range of cancer treatment options for patients on the Northshore. Now, with nationally recognized Ochsner Health System, the most trusted names in cancer care are delivering integrated cancer services in one convenient location, connected via skybridge to the hospital’s main campus.
St. Tammany Parish Hospital is accredited by the American College of Surgeons Commission on Cancer as a Comprehensive Community Cancer Center and the National Accreditation Program for Breast Centers (NAPBC).
The Harold-Leever Cancer Center Streamlines Cancer Conference Operations with OncoLens—a Multidisciplinary Cancer Care Platform
Cancer programs strive to provide high-quality, patient centered care and access to the full scope of cancer services required to diagnose, treat, rehabilitate and support cancer patients. The Commission on Cancer (CoC) accreditation provides cancer programs an organizational model for the delivery of comprehensive multidisciplinary care. The CoC, National Accreditation Program for Breast Centers (NAPRC) and National Accreditation Program for Rectal Cancer (NAPRC) assures patients and payers that the highest standards of cancer care are being provided to patients.
CoC standard ER-3, NAPBC standard 1.2 and NAPRC standard 1.3 and 1.4 define the Multidisciplinary Conferences (Tumor Boards) as essential for timely discussion of patients to improve outcomes. Tumor Boards have been conducted at The Harold-Leever Cancer for more than 12 years. We currently run four total Tumor Boards with an average of 24 breast conferences/ year, 12 GI conferences/year, 12 Thoracic Conferences/year and three UroOncology Conferences/year.
The Center’s former process involved sending a request for cases to all of our provider teams. Case information received via often unsecure email or text messages or telephone would involve a patient name and DOB with no clinical history. Names received would often be illegible and cases had to be researched for clinical history. Care had to be taken to put cases on the correct conference especially with several conferences happening in a week. The conference coordinator would then manually create an agenda with information regarding the pathology and radiology image locations that had to be sent to the correct departments. There were many email and phone exchanges between various departments to ensure all the data was accurate for a smooth presentation.
Additionally, significant work occurred if cases were added to the conference at the last minute. On the day of the conference, the metrics relevant to the CoC accreditation process was manually written down for collation later. All of these labor-intensive processes posed a significant workload for the cancer center.
“As a forward-looking institution, we felt that a technology platform could help improve the quality of our Tumor Board process and discussions,” said Kevin Kniery, Executive Director, The Harold Leever Regional Cancer Center. “We selected the OncoLens platform and implemented it in January, 2018. The OncoLens platform is a HIPAA compliant SaaS platform with a companion iPhone app that allows anyone on the cancer team to submit a case for discussion. The platform automatically creates agendas and routes the cases to all members of the Tumor Board. Administrator training took two hours. We rolled out this new platform first with our breast conference and then to our other conferences. We were up and running with all four conferences by the end of two months. Cases are submitted by nurse practitioners and physicians through cancer specific templates to enable ease of case data entry. The templates are filled out with more complete data that can be modified at any time.”
“The completeness of the data takes the stress off of the administrative team who previously had to spend hours researching cases for conferences.”
Kniery continued, “The completeness of the data takes the stress off of the administrative team who previously had to spend hours researching cases for conferences. We have observed that what used to take up to two days to prepare 15 cases now takes one half day. Unlike in the past, the cases are available much faster, and agendas are automatically created and routed to radiology and pathology. The cases are automatically placed into the correct conference date which is very helpful when conferences are bunched together in the week. On the day of the conference the CoC and NAPBC metrics are collected and stored for future use. We now have easy access to cases that were discussed in the past and these cases can easily be discussed again when they complete various lines of that therapy. Our tumor registrar now has easy access to pull reports when she needs them rather than requesting them from us.”