20
VHA INNOVATION PROGRAM Innovation #719 Adding OncoTrax Cancer Data Tables to Corporate Data Warehouse “What Gets Measured, Gets Managed!” – Peter Drucker Summary Presentation to innovation program and VAi2 Staff September 25, 2013

VHA INNOVATION PROGRAM Innovation #719 Adding OncoTrax Cancer Data Tables to Corporate Data Warehouse “What Gets Measured, Gets Managed!” – Peter Drucker

Embed Size (px)

Citation preview

VHA INNOVATION PROGRAMInnovation #719 Adding OncoTrax Cancer Data Tables to Corporate Data Warehouse“What Gets Measured, Gets Managed!” – Peter Drucker

Summary Presentati on to innovati on program and VAi2 Staff

September 25, 2013

VETERANS HEALTH ADMINISTRATION

Project Background

• Problem Statement – VHA does not currently store cancer data in a form or in a place where it can be accessed and used by VA cancer practitioners and stakeholders. This situation has caused the following problems:

– There is a lack of comprehensive, aggregated cancer data to access.– Retrieving the data that is collected is a very difficult process.– There are insufficient checks on the data that is collected because no one is using it.– Vital Quality Assurance data must be pulled at individual facilities, making it difficult to compare facilities or to look at

VISNs overall.– Because aggregated data is not accessible, it is difficult to determine whether accepted practices at the VA are always

the best choice for the unique needs of the Veterans.

• Description of Proposed Solution – OncoTrax cancer data is being incorporated into the VHA’s Corporate Data Warehouse (CDW) where it can be accessed through cubes (National Cancer Care Cube Project or Cube) that are built, tested and maintained by the VHA Support Service Center (VSSC). Access to the Cube will be given to cancer stakeholders according to their access rights.

– VA practitioners will be able to see trends across a larger population of cancer patients and more accurately benchmark their cancer programs’ performance based on the reality of the cancer patients’ experiences.

– Access to aggregated cancer data will enable the establishment of business cases for new technology and equipment.– Cancer care data can be cross referenced with administrative and business practice data enhancing the quality of

business decisions regarding cancer care.

2

VETERANS HEALTH ADMINISTRATION

Execution Status

• Approach to Solution and Major Objectives – Cancer Registry data is being pulled regularly from the facilities across the country into the CDW and used to populate data cubes which are developed by VSSC. Those cubes allow for an easier way to assess the data and use it for predetermined decision-making purposes. Other goals that will be eventually realized:

– Cost Savings– Improved patient safety– Veteran Satisfaction– Operational Efficiency

• Execution Status – Cancer data that is recorded in OncoTrax from every VA Medical Center that cares for cancer patients is being uploaded bi-weekly into the CDW raw. The tables are nearing completion and the National Cube will be in its testing phase to limited stakeholders by mid-September.

• Project Background and VISN 16 Pilot – In 2010, program managers in VISN 16 were unable to verify information that was needed to support business decisions in cancer care because that data was not available to them. The Cancer Data Program Analyst, in her pursuit of the requested information, developed a plan to aggregate data from the Cancer Registry and the VISN 16 Cube was born. That Cube has served as a pilot for what is now developing into the National Cancer Care Cube, a tool which will make cancer data available for cancer stakeholders across the country.

3

VETERANS HEALTH ADMINISTRATION

Business Case

• What value does this project create?– Clinical –The Cube will help improve the quality of care by making the full “picture” of how the VA diagnoses and

treats cancer available for evaluation by the providers themselves.– Cost Savings – The project will make a financial impact by providing information about where resources are needed

and therefore facilitating the decision-making process around matching resources to the need. The information will also allow for products and services to be purchased in a more comprehensive way.

– Improve Patient Safety – Providers can make more effective and safer choices for cancer treatment when they are informed of the efficacy of treatments and follow up that are used as a matter of VA accepted practice.

– Veteran Satisfaction – The Cube will help to create a patient-centered information resource that will enable practitioners to learn from the past history of patients in similar situations.

– Operational Efficiency – Access to cancer data that is stored in the same system as other clinical and business elements will enable a cross referencing of data to create a complete and comprehensive picture of current processes, current spending, current successes and challenges.

– Overall Improvement in Oncology Management – According to business management experts, the simple act of paying attention to VA processes will cause participants to make connections never made before, and improvement will happen almost without any extra effort. Access to data will enable cancer stakeholders to look at past and current processes and measure success and/or failure.

• Status of Business Case - Innovation 719 Phase I is nearing completion. Cancer data that is recorded in OncoTrax from every VA Medical Center that cares for cancer patients is uploaded into the CDW on a bi-weekly basis. The tables are nearing completion and the National Cube will be in its testing stage to limited stakeholders by mid-September.

4

VETERANS HEALTH ADMINISTRATION

ISB Selection Criteria

5

Criteria See… Self-Assigned Score

Compliance Slide 5 1

Five-Year Net Operational Cost Change Slide 6 1

Implementation Cost Slide 7 & 8 -5

Clinical Impact (Broadness) Slide 9 5

Clinical Impact (Degree) Slide 9 10

Business Impact (Broadness) Slide 10 5

Business Impact (Degree) Slide 10 10

Patient Safety Slide 11 3.7

Patient Value Slide 12 5

Healthcare Disparity Slide 13 1

Summary Value = 1 * (11+24.7) = 35.7

Business Value = 1 + (-5) + 5 + 10 = 11

Clinical Value = 5 + 10 + 3.7 + 5 + 1 = 24.7

VETERANS HEALTH ADMINISTRATION

Business Case – Compliance

• The solution is compliant with regulations.

- Use of the Cancer Care Cube will be governed by access determined at the facility level, which assures 508 Compliance. Facility ISOs are trained to recognize the need for reasonable accommodation and can take individual needs into account.

6

Self Assigned Score: 1

VETERANS HEALTH ADMINISTRATION

Business Case – 5-Year Net Operational Cost Change

7

• In FY2011, one of the cancer program managers in a VISN 16 facility launched a review of Medical Center (MC) cancer data on stage IV cancers for that year, using the VISN 16 Cancer Cube. She hoped to verify that patients were appropriately classified to the Metastatic Cancer Patient Class, therefore confirming that the MC was receiving appropriate funding support for those patients.

Result: the patients had indeed been miscoded and through the manager’s diligent use of the Cube, was able to recover a projected $178,188 of VERA funds for each of the FY budgets for 2013, 2014, and 2015.

Assumption: If there was miscoding at one facility and it made this kind of a difference, then there is no double that there will be other opportunities for funds recovery at other facilities with similar circumstances. Because there has been no reliable cancer data source at the national level, then the numbers of patients with metastatic disease is only speculation. However, if the MC is any example, this one instance alone could possibly mean over a half a million dollars in additional funding over three years.

• The Cube could offer ease of access to business data, eliminating the speculation and bring to the VA Oncology sound decision-making practices for a broader array of business opportunities.

Self Assigned Score: 1

VETERANS HEALTH ADMINISTRATION

Business Case - Implementation Costs - FTEs

8

Year 1 Year 2 Year 3 Year 4 Year 5

Pilot Phase $142,043 $0 $0 $0 $0

Deployment Phase $0 $150,000 $0 $0 $0

Annual Total $0 $ $150,000 $150,000 $150,000

Cumulative Costs $142,043 $292,043 $442,043 $592,043 $742,043

Self Assigned Score: -5

VETERANS HEALTH ADMINISTRATION

Business Case - Implementation, Marketing Campaign/Rollout (No additional costs at this time)

Possible marketing and media to be included without additional costs include:• The Weekly Educator-Email newsletter which is sent to nearly 8,000 VHA learning leaders /

subscribers including several key email lists. Stories are often copied from the newsletter and reposted or emailed.

• E-blasts or email-based program announcements targeting specific groups in the oncology community and others which would help spread the word to VAMC and VISN medical leaders and educators, as well as to VAMC Public Affairs Officers who use a variety of media to communicate within their facilities as appropriate, depending on the target audience.

• Posting on the EES External Website which has nearly 30,000 visitors per month.• Partnering with VHA Communications who have recently launched national campaigns for

the Strategic Plan and other programs/events to assist with ideas and/or distribution.• EES graphics possibly assisting in developing digital graphics to help illustrate what the Cube

does, much like an “infographic.”

9

VETERANS HEALTH ADMINISTRATION

Business Case – Clinical Impact

• Broadness: This solution positively impacts clinical performance metrics in that measurement becomes a standard part of business for a broader segment of the workforce.

10

Self Assigned Score, Broadness: 5 Self Assigned Score, Degree: 10

Clinical Performance Metric Degree of Impact

Timeliness – Time from first symptom to diagnosis 10% - 15%*

Timeliness – Time from diagnosis to first treatment 10% - 15%*

Follow up of cancer patients post treatment 25% - 30%*

*When performance measures were applied to MC data in these topic areas over time in VISN 16, the impact was positive almost without exception. These percentages are estimates based on the changes that occurred as witnessed by the program leadership between 2009 and 2012.

• Degree: This solution positively impacts these metrics in the following ways

- Improves communication among a broader segment of patient care teams (by providing the same information for everyone)- Improves quality of care by providing data for clinical studies to assess survival and prognostication (improves those outcomes)- Allows for the examination of patient experiences over time to check for rising use of radiation or specific chemotherapy agents, and the costs of those treatments- Allows for the evaluation of VA standards of treatment and outcomes from those standards- Will make the full “picture” of how the VA diagnoses and treats cancer available back to the providers themselves for

evaluation purposes

VETERANS HEALTH ADMINISTRATION

Business Case – Business Impact

• Broadness: This solution positively impacts five business performance metrics

11

Self Assigned Score, Broadness: 5Self Assigned Score, Degree: 10

*These percentages are estimates based on discussions with team members and participants of various presentations made by the Innovation 719 Team.

• Degree: This solution positively impacts these metrics in the following ways- Will provide access to information that will help practitioners standardize the way they order and deliver

chemotherapy- Will allow a cross referencing of data with other business units- Will enable more sound decision making regarding the placement of resources

Business Performance Metric Degree of Impact

Improves accuracy of decision making 20% improvement*

Allows for specific examination of chemotherapy choices overall (standardization of best practices) 15% improvement*

Enhances data access, integrity, and aggregation (quality of work) 20% improvement*

Reduces program or organizational risk (quality of work) 15% improvement*

Reduces costs by helping to target the best use of resources 15% improvement*

VETERANS HEALTH ADMINISTRATION

Business Case - Patient Safety

• This solution demonstratively improves patient safety- Providers can make more effective and therefore safer choices for cancer treatments when they are informed of the

efficacy of treatments and follow up that are used as a matter of VA accepted practice. The Cube will allow access to aggregated national data that will tell the story of VA patients’ cancer experiences. (And things that get measured, get addressed.)

Evaluation CriteriaScored -10 to 10 where -10 is severe decrease in patient safety, 0 is no change in patient safety and +10 is very strong impact in patient safety1. Demonstratively reduces preventative harm in this population. 32. Reduces mortality and morbidity in this population. 33. Improves patient safety by demonstratively reducing the chance of human error. 5

ADDITIONALLY:– The availability of information on past treatment choices over a larger patient population gives providers important tools

when making decisions regarding current patient care.– Providers can also see what diagnosis or treatment options that colleagues in other VISNs or Regions have provided to

patients, meaning that patients will be more often treated equally across VISNs or Regions. – With proof of the past at their fingertips, providers can, with confidence, promote positive outcomes in their patients by

making safer, more equitable choices.

12

Self Assigned Score: 3.7

VETERANS HEALTH ADMINISTRATION

Business Case – Patient Value

• This solution significantly increases patient satisfaction– The Cancer Care Cube will help to create a patient-centered information resource that will

enable practitioners to learn from the past history of patient in similar situations. There is no better resource for decision making regarding patient care than data that expresses the patient’s own experiences.

– Information from the Cube will help to improve timeliness from diagnosis to treatment when provider teams are confident about decisions.

– Treatment options can be more closely tested and verified in the unique Veteran population.

13

Self Assigned Score: 5

VETERANS HEALTH ADMINISTRATION

Business Case – Healthcare Disparity

• This solution does not address a healthcare disparity except that it leaves no one’s story out. The Cancer Registries of VA Medical Centers that treat cancer patients capture every case, and strive to capture everything pertinent to cancer about that case.

14

Self Assigned Score: 1

VETERANS HEALTH ADMINISTRATION

Screen Shot of Cube View

Measures: Unique patients or casesAccession YearCancer First Tx DateCancer First Tx: (Single/Multi tx listed BRM, CMX, SUR, XRT)Cancer Patient: Demographics (Age, Marital Status, Gender, Race, Deceased, Class Category, Location – County, State, Date Dx, Facility site)Onc Primary SiteOnc StageTx: CTX, HT, BRM, OTHER, XRT, SUR (Single Agent, Multiagent, WLE, Total, Radical, Beam, None, Pt deceased, Refused)

Future: Histo-MorphologyPerformance StatusDisease StatusSurvival YearsPerformance Measures

Here is Cube view with an array of measures and dimensions. A measure is anything that can be quantified – for our measure we identified the number of unique patients and the number of cancer cases.

A Dimension is anything that can be summarized – we created a dimension with demographics, cancer sites, stage, treatments. The beauty of using a Cube is that multiple values can be selected for a specific dimension and then the user can drill down and create exactly the report that is needed.

VETERANS HEALTH ADMINISTRATION

  CMX NTX

SUR

XRT

CMX NTX

SUR

XRT CMX NTX

SUR

XRT CMX NTX

SUR

XRT

  I       II       III       IV      ALX 0 0 16 11 0 0 10 14 20 10 0 10 10 24 0 19

BIL 0 0 0 10 0 0 7 0 15 0 0 0 9 5 0 15

FAV 10 10 7 5 0 8 9 4 15 9 0 3 16 12 0 1

HOU 8 11 40 20 11 15 18 11 25 12 16 12 28 25 4 18

JAC 3 8 14 10 5 12 3 0 24 7 7 0 26 11 2 15

LIT 10 10 25 10 7 9 10 11 25 8 3 10 35 4 4 8

MUS 3 3 10 1 0 2 7 3 14 1 4 1 15 15 5 10

NOL 0 11 7 7 0 4 5 4 5 0 2 7 8 8   16

OKL 3 9 15 9 4   8 10 10 11 4 19 8 15 2 23

SHR 0 9 19 9 9 0 10 2 11 13 0 6 12 14 0 22

Cases for 2010 Lung, Not Otherwise Specified by Facility (Fictitious numbers)

Here is a fairly simple report where lung was determined as the site specific dimension; in the year 2010; with the top four primary cancer treatments per facility. This is but one early example of how the Cube can speed up a query for aggregated lung cancer data. Note the indication of patients by stage of disease.

Draft Data Report Created Using the Cube

VETERANS HEALTH ADMINISTRATION

Support for Innovation and Next Steps

The Cancer Care Cube project was conceived because of a need. In 2010, the principle innovator couldn’t find the data that her boss was demanding to see so she, wondering why, approached a Region 2 programmer at the VISN 16, 2010 Cancer Care Symposium. That’s when it was decided that the Cube idea in VISN 16 would be supported. The VISN Cube worked so well, that the innovator decided to join forces with others to create what is now referred to as Phase I of the National Cancer Care Cube.• Several of the principle players that were approached to do the programming for the Cube had moved up

through the ranks of VSSC and the Corporate Data Warehouse, but were originally from Little Rock. Therefore there was a bond of trust that existed among team members from the long histories together.

• This bond allowed them to work closely together without concern for giving or taking credit and the result was the formation of a team that was totally sold on the viability of the project.

• This commitment by team members to the project led to fruitful discussions among Senior VSSC leadership, Joe Francis, CDW leadership, Dr. Joseph Reeds, and the National Oncology Program Director, Dr. Michael Kelley. The project received full support from all three.

• Presentations were delivered at national meetings and VISN 16 annual Symposia. Demonstrations of templates and prototypes of the Cube and the draft training materials were introduced at VISN 16 Cancer Care Committee bi-monthly calls. The exposure has had the result of encouraging VISN 16 providers to use the VISN 16 Cube, and inquire about the timeline for the National Cube. Requests from outside the VISN have begun to come in which confirms the interest that is being raised just by word of mouth among various national committees and special interest groups.

17

VETERANS HEALTH ADMINISTRATION

Support for Innovation and Next Steps, Cont.

To move this Innovation into Phase II (national rollout), funding and support from VHA leadership is needed to complete the following steps:

• VSSC programming activities should be supported in the way of a continued full-time FTEE. The Cube will be operational very soon, but there will be detailed datasets that will still need to be added. As the technology and software for the capture of information at the bedside evolves, there will be ever increasing categories of data points that will need to be built in. There will also be a considerable library of templates that will be maintained and used for the usual reporting of data, for such things as performance measures and information on costs. Also, as the Cube is used more and more, people will devise new uses for the data, thereby needing more relevant templates, or templates designed for specific purposes.

• Quality assurance for the cancer registry data should also be supported by a Registry expert/ Certified Tumor Registrar.

• A national rollout will be needed to market the Cube and make VA cancer stakeholders aware of the new resource that is becoming available.

• Education and training for users will also be required once people are made aware of the Cube.

18

VETERANS HEALTH ADMINISTRATION

Details of Business Case – Tangible Benefits/Value

Just to reiterate, we believe that the following will occur just because this data base of information will be made available to cancer stakeholders in the VA Medical Centers:

• There will be a rise in the quality of Registry data due to the scrutiny brought by regular use.• We would expect a decline in less than optimum choices made at the bedside because of proof of

outcomes in similar cases.• More mistakes will be avoided – mistakes caused by the inability to track trends in treatment regimens.• There will be a rise in evidence-based decision making due to new availability of cancer data.• We can expect a more targeted placement of resources, responding to the actual needs of the patients.• There should be an increase in revenue generated as a result of corrections to miscoded staging data.• There will be an increase in the rate of compliance with cancer care performance measures as data for

tracking will be easily available.

19

VETERANS HEALTH ADMINISTRATION

The Team

• Melody Darbe, MSN– Region 2 Programmer

• Teresa Stevens, BA– VSSC Programmer

• Pat Coke, CTR– VISN 16 Data Analyst

• Tina Gill, MAIOC– VISN 16 Cancer Program Manager

20