Auto-Populating Hospital Cancer Registry Data into Survivorship Care Plans

Contact Name: 
Laura P. Ruppert Cancer Surveillance Section Director Division of Chronic Disease, Primary Care, and Rural Health Indiana State Department of Health
Name of Institution, Organization or Community Where the Project Was Implemented: 
Hancock Regional Hospital and Indiana State Department of Health
Description of Project Setting: 

Hospital, Cancer Center

Category: 
Patient Navigation
Survivorship
Subcategory: 
Barriers to Care Access
Care Coordination
Skills
Staff
Survivorship Care Plans
Survivorship Models
Timeliness to Care
Target Population: 
Rural
Cancer Site: 
Non-Specific
Project Description: 

The Cancer Control Section (CCS) at Indiana State Department of Health collaborated with Hancock Regional Hospital (HRH) Sue Ann Wortman Cancer Center on a project to pilot the development of survivorship care plans (SCPs) by auto-populating the hospital’s cancer registry data from Rocky Mountain Cancer Data Systems (RMCDS) into the Journey Forward SCP template. The goal of this effort was to provide cancer patient case data needed for SCPs while decreasing the time it takes staff to develop them. 

Problem or Issue the Project Was Designed to Address or Improve: 

At HRH, developing SCPs can take between 1.5-2 hours to complete due to the time-consuming task of gathering the necessary patient data, which can be scattered between the provider base, as well as manual entry of these data into a SCP. 

Difficulties Encountered in Planning, Implementing, Evaluating or Sustaining the Project: 
An initial test to auto-populate a SCP from RMCDS into Journey Forward revealed the following challenges: the patient navigator, who has limited time, was responsible for importing patient RMCDS files into Journey Forward and entering patient information manually; the medical oncologist’s contact information was not loading into the correct field; exporting SCP files using a subset, which allows the patient navigator to work with a part of the patient abstract cases rather than all of them, was time-consuming; and development of the SCP needed additional time. The project was designed to address the challenges of the initial test run to auto-populate SCPs. One improvement made by RMCDS was that the patient navigator is now able to develop a SCP in each individual patient file negating the need to create a subset. However, barriers still existed in the implementation process, namely challenges with data extraction and transfer errors, which required troubleshooting. For example, chemotherapy medication information was not loading into the correct field and some coded diagnosis data still displayed as code in Journey Forward. There were other data transfer issues for different cancer types because templates for cancer types other than breast were not fully developed.
Project Successes: 
While the project has not yet created or drastically improved the auto-population of SCPs, it has begun laying the groundwork for auto-populating SCPs at HCH. The following are highlights from this strategic partnership: project staff see the value of the intervention for the cancer patient as evidenced by quarterly progress reports (staff are spending more time on action plans and are engaged in problem-solving); a process is now in place for identifying issues with data auto-population; this includes a team consisting of the certified tumor registrar, software programmer and patient navigator; open communication and buy-in from the patient navigator to gather and discuss SCP auto-population issues; and increased capacity to address issues through hiring of additional staff, training, and sharing of resources and information with statewide coalitions and other partners.
Helpful Information Before the Project Started: 
It would have been helpful to know how knowledge is shared between patient navigators and physicians at HCH, how data is extracted, how HCH’s software programs interface and how errors encountered during auto-population can be resolved.
Project Significance: 
Improved internal processes to make the creation of a SCP more efficient. Provided promising practices for HCH’s Oncology Department which can help systems continue to meet Commission on Cancer-accreditation standards and provide a better standard of care for patients to empower them to confidently transition back into a healthy and productive lifestyle. Helped oncology partners understand patient needs and what patients value most during their cancer treatment.
Lessons Learned for Patients, Caregivers and/or Communities: 
A SCP is an important tool that can be used and shared by patients, caregivers and communities so that patients can continue to receive the best care after completing treatment and build a foundation for healthy lifestyle behaviors to keep them healthy and active members of their community. A SCP will help provide an understanding of the resources available to patients so they don’t feel alone after completing their treatment and can continue to move forward with their lives.
Lessons Learned for Clinicians or Health Care Professionals: 
Auto-populating SCPs takes time and patience and the process will not be perfect at first. It is important to persevere through challenges and make the process as smooth possible.
Lessons Learned for Researchers or Additional Research Needed: 
Further research should explore: how systems track the benefit, effectiveness and utilization of SCPs given the time it takes to develop them; the most appropriate data and metrics that smaller hospital systems and cancer centers can collect and apply to build their capacity in auto-populating cancer case data; how can electronic medical record systems help support timely development of SCPs and ways to improve their workflow in the hospital; how to optimize care coordination and keep up with the increasing standards of SCP development and delivery; and to what extent SCPs enhance quality and duration of life for cancer patients.
Additional Information: 
The CCS is funded through the Centers for Disease Control and Prevention award number DP15-1501 titled “Increasing the Implementation of Evidence-Based Cancer Survivorship Interventions to Increase Quality and Duration of Life among Cancer Patients”. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. The CCS entered into a contract with HRH to test auto-populating SCPs and to increase capacity and infrastructure to better address cancer survivorship at the local level.