Treatment Summary

University of California San FranciscoCenter 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.© 2007 Laura J Esserman

Improving Quality of CareUCSF Roadmap Strategy

Z

Patient Entered Data

Intake, Sx, Follow-up

MD Pt Collaborative

SpaceCare 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

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

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

Treatment Summary: Step 1MD/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 XRT Chemo Biologics HormonalChoices

2006 Jan April July Sept

Chemo XRT

Biologics

Surgery

+Hormonal

Hormonal

2006 Jan April July Sept

Surgery XRT Hormonal

Treatment Summary: Step 2MD updates Care Plan with patient at each visit

Surgery XRTChemo 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

Treatment Summary:Embedded within Longitudinal Patient

History

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.

Treatment Summary:Underlying Architecture

Document Store

Index

Service Layer

Presentation Layer

Data M

apping

1. Data Input and Export

2. Document Storage3. 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

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 RequirementsSingle point of access to information collated from multiple sourcesIntegration with existing healthcare applicationsConsumer privacy and confidentiallyEnhanced user experienceAlerts and reminders

Diagnostics