EMR-linked cancer tracker facilitates lung and liver cancer care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 77-77 ◽  
Author(s):  
Tamar H. Taddei ◽  
Laura Hunnibell ◽  
Anne DeLorenzo ◽  
Mirta Rosa ◽  
Donna Connery ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Cancer Care ◽  
Tracking System ◽  
Treatment Plan ◽  
Safety Net ◽  
Easy Access ◽  
Web Based ◽  
Lung Cancers ◽  
Radiology Reports

77 Background: VA Connecticut Healthcare System has developed a web-based, EMR-linked Cancer Care Tracking System (CCTS) to facilitate tracking and follow-up of patients with imaging abnormalities concerning for lung or liver cancer. The tracker was developed to facilitate the efforts of a multidisciplinary team at the center of which is a cancer navigator. Methods: CCTS was first envisioned in 2007 when VACT hired a care navigator and implemented a radiology coding system to identify potential cancers. This created the need for a tool to process abnormal images and track the clinical steps required to reach a definitive diagnosis and treatment plan. CCTS was initially used for lung cancers and was expanded to track hepatocellular carcinoma (HCC) in 2009 with additional funding. In addition to case discovery, it offers easy access to patient information with live links to the VA EMR, a surveillance feature, and scheduling, alerting, and reporting functions. In 2011, the system was enhanced with a natural language processing (NLP) program that automatically identifies radiology reports describing potentially malignant lung or liver lesions. Results: CCTS has been in daily operation since February 2010, with 1,778 patients and 2,503 patients tracked in 2010 and 2011, respectively. Addition of NLP technology significantly increases the accuracy of identification of patients with lung or liver nodules. The NLP system identified 21% of all new cases with potential malignancies whose management could have been delayed through coding omissions or errors. Benefits of CCTS and our cancer care coordination program have included a decrease of 25 days in the time from abnormal image to treatment of lung cancer, a significant increase in the diagnosis of stage I/II lung cancers from 32% to 48%, and an increase in the incidence of liver cancer from 1% to 5% of all cancers at VACT. Conclusions: A web-based, EMR-linked cancer care tracking system (CCTS) improves cancer detection, prevents loss to follow-up, provides a safety net for radiology coding omissions or errors, and improves provider efficiency. CCTS is an innovative tool to support multidisciplinary cancer care and has broad applicability to any electronic medical record.

What fixes can improve cancer care quality at safety-net hospitals?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 243-243
Author(s):  
Nina A. Bickell ◽  
Alexandra Moss ◽  
Bonnie Bellacera ◽  
Rebeca Franco ◽  
Ann Scheck McAlearney
Keyword(s):  
Breast Cancer ◽  
Private Practice ◽  
Cancer Care ◽  
Organizational Factors ◽  
Safety Net ◽  
Poor Quality ◽  
System Support ◽  
Patient Centered ◽  
Web Based

243 Background: Safety-net hospitals are at higher risk of poor quality cancer care and vary in levels of quality performance. Types of quality problems may differ and require different interventions. We undertook this study to identify organizational factors affecting quality and assess the early findings of the innovation’s impact on hand-offs between specialists. Methods: As part of a RCT testing a web-based tracking and feedback innovation to close referral loops, new breast cancer cases are rapidly ascertained, and post-surgical medical and radiation oncologist visits are assessed. Surgeons are alerted to patients who do not show to oncology visits to stimulate action. Of 153 enrolled women (98 Intervention/ 55 Control), 4% are white. In addition, we conducted 90 key informant interviews in 9 safety-net hospitals in the NYC metropolitan area and performed a qualitative comparative analysis (QCA), a method to assess causal complexity, to identify organizational factors associated with poor quality. Results: No-shows at oncology appointments triggering surgeon feedback occurred for 5/98 (5%) new breast cancer patients. QCA revealed 6 conditions associated with poor quality-defined as underuse of needed adjuvant treatment: information sharing; follow-up; system support; patient-centered culture; flexibility and private practice. All high-performing hospitals had a patient-centered culture, strong follow-up approaches and shared information. Some of these high-quality sites had robust system support while others had creative workarounds (flexibility) or were responsive to their private practice patients. Overall, these pathways had high consistency (.88) and coverage (.72). Only hospitals with both poor follow-up and system support activated the web-based feedback. Conclusions: Safety-net hospitals with poor follow-up capabilities may benefit from an innovation designed to improve hand-offs across specialties. This trial continues to accrue; we are monitoring the innovation’s effectiveness. Clinical trial information: NCT01544374.

A Simple Web-Based Image Database System for Facilitating Medical Care in Dermatological Clinics

2012 ◽  
pp. 502-513
Author(s):  
Takeshi Toda ◽  
PaoMin Chen ◽  
Shinya Ozaki ◽  
Kazunobu Fujita ◽  
Naoko Ideguchi
Keyword(s):  
Image Database ◽  
Database System ◽  
Medical Examination ◽  
Easy Access ◽  
Health Record ◽  
Health Records ◽  
Web Based ◽  
Internet Server ◽  
Electronic Health

In Japan, electronic health record systems are gradually becoming popular at large hospitals, but are not yet frequently implemented in clinics. This is due to both prohibitive costs and a lack of interest in checking electronic health records on the part of patients. Doctors also may be opposed to showing patients their health records, as it then may require a doctor to let patients observe images to check for improvement of symptoms at follow-up. In this study, the authors developed a database system of dermatological images accessible to both doctors and patients. In this system, doctors can photograph affected skin areas and tag the images with keywords, such as patient ID or name, disease or diagnosis, symptoms, affected bodily regions, and free wards. The images and keyword tags are transmitted to a database housed on an Internet server. The authors implemented this system on a smartphone for quick and easy access during medical examination and on a tablet terminal for patients to use while waiting in the clinic. Using the tablet terminal, a doctor and patient may check for improvement of symptoms together.

scholarly journals Gap between desired and self-determined roles of general practitioners: a multicentre questionnaire study in Japan

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takashi Chinen ◽  
Yusuke Sasabuchi ◽  
Kazuhiko Kotani ◽  
Hironori Yamaguchi
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
Survivorship Care ◽  
Web Based ◽  
Care Continuum ◽  
Cancer Care Continuum ◽  
Cancer Specialists

Abstract Background Primary care physicians have diverse responsibilities. To collaborate with cancer specialists efficiently, they should prioritise roles desired by other collaborators rather than roles based on their own beliefs. No previous studies have reported the priority of roles such clinic-based general practitioners are expected to fulfil across the cancer care continuum. This study clarified the desired roles of clinic-based general practitioners to maximise person-centred cancer care. Methods A web-based multicentre questionnaire in Japan was distributed to physicians in 2019. Physician roles within the cancer care continuum were divided into 12 categories, including prevention, diagnosis, surgery, follow-up with cancer survivors, chemotherapy, and palliative care. Responses were evaluated by the proportion of three high-priority items to determine the expected roles of clinic-based general practitioners according to responding physicians in similarly designated roles. Results Seventy-eight departments (25% of those recruited) from 49 institutions returned questionnaires. Results revealed that some physicians had lower expectations for clinic-based general practitioners to diagnose cancer, and instead expected them to provide palliative care. However, some physicians expected clinic-based general practitioners to be involved in some treatment and survivorship care, though the clinic-based general practitioners did not report the same priority. Conclusion Clinic-based general practitioners prioritised involvement in prevention, diagnoses, and palliative care across the cancer continuum, although lower expectations were placed on them than they thought. Some additional expectations of their involvement in cancer treatment and survivorship care were unanticipated by them. These gaps represent issues that should be addressed.

A Simple Web-Based Image Database System for Facilitating Medical Care in Dermatological Clinics

2012 ◽  
pp. 385-397
Author(s):  
Takeshi Toda ◽  
PaoMin Chen ◽  
Shinya Ozaki ◽  
Kazunobu Fujita ◽  
Naoko Ideguchi
Keyword(s):  
Image Database ◽  
Database System ◽  
Medical Examination ◽  
Easy Access ◽  
Health Record ◽  
Health Records ◽  
Web Based ◽  
Internet Server ◽  
Electronic Health

In Japan, electronic health record systems are gradually becoming popular at large hospitals, but are not yet frequently implemented in clinics. This is due to both prohibitive costs and a lack of interest in checking electronic health records on the part of patients. Doctors also may be opposed to showing patients their health records, as it then may require a doctor to let patients observe images to check for improvement of symptoms at follow-up. In this study, the authors developed a database system of dermatological images accessible to both doctors and patients. In this system, doctors can photograph affected skin areas and tag the images with keywords, such as patient ID or name, disease or diagnosis, symptoms, affected bodily regions, and free wards. The images and keyword tags are transmitted to a database housed on an Internet server. The authors implemented this system on a smartphone for quick and easy access during medical examination and on a tablet terminal for patients to use while waiting in the clinic. Using the tablet terminal, a doctor and patient may check for improvement of symptoms together.

scholarly journals 351 – Cancer Tracking System Improves Timeliness of Liver Cancer Care At a Veterans Hospital

2019 ◽  
Vol 156 (6) ◽  
pp. S-1192
Author(s):  
Yapei Zhang ◽  
Rajni Mehta ◽  
Tamar H. Taddei
Keyword(s):  
Liver Cancer ◽  
Cancer Care ◽  
Tracking System

Prospective study of an AI enabled online intervention to increase delivery of guideline compliant cancer care, on the ground.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2011-2011
Author(s):  
C S. Pramesh ◽  
Bhawna Sirohi ◽  
Shona Milon Nag ◽  
Sudeep Gupta ◽  
Benjamin O. Anderson ◽  
...  
Keyword(s):  
Prospective Study ◽  
Primary Tumor ◽  
Cancer Care ◽  
Treatment Plan ◽  
Online Intervention ◽  
Expert Review ◽  
Treatment Plans ◽  
Tumor Distribution ◽  
To Receive

2011 Background: Despite survival benefits of guideline compliant cancer care, under treatment and over treatment are prevalent. Navya is an AI enabled online intervention that matches a patient’s medical record with NCCN and NCG guidelines (National Cancer Grid, India) and layers live multidisciplinary expert review to recommend actionable treatment plans. It was developed to standardize care and mitigate morbidity and mortality, by delivering on-t ime, guideline based expert treatment plans. Methods: From July 2019 to January 2020, all patients who received a Navya treatment plan based on guidelines and live expert review were included. Intended treatment plans were prospectively collected from the patient. Compliance of intended plans with NCCN (including Resource Stratified Framework) or NCG was measured. Noncompliant intended plans were categorized as overtreatment or undertreatment. After delivery of Navya plan, prospective phone follow up assessed whether noncompliant intended plans were changed to guideline compliant care. Results: Of 1707 consecutive patients who received a Navya plan, 1549 intended plans were available. Patients were diverse with respect to geographic, socioeconomic, and primary tumor distribution: West of India: 28%, North: 26%, East: 21%, South: 15%, Central: 7%, International: 3%; 35% of patients with income < $300/month; GI: 23%, Breast: 14%, Head & Neck: 11%, Thoracic: 10%. Of the 1549 intended plans, 441 (28.47% (95% CI ± 0.26%)) were not compliant with NCCN or NCG. Undertreatment was 35%, overtreatment 26%, incomplete staging workup 28% and 11% could not be categorized. Of 441 patients with noncompliant intended plans, 80.19% (± 0.97%) shared the Navya plan with their treating oncologists and 50.40% (± 0.88%) changed their intended plan to receive the Navya treatment plan. Intervention with Navya increased on-the -ground guideline compliance by ~15% (from 71.53% ±0.42% to 85.87% ± 1.73%). Conclusions: Guideline compliant care ensures best achievable clinical outcomes with existing therapies. A technological earthshot that significantly increases adoption of guideline based care is the first step towards cancer moonshots.

Action required: Web-based personnel surveys and the importance of follow-up

2003 ◽  
Author(s):  
Lori Foster Thompson ◽  
Eric A. Surface ◽  
Don L. Martin ◽  
Gary B. Barrett
Keyword(s):  
Web Based

Exploring Nanoemulsion for Liver Cancer Therapy

2020 ◽  
Vol 16 (4) ◽  
pp. 260-268
Author(s):  
Tanmay Upadhyay ◽  
Vaseem A. Ansari ◽  
Usama Ahmad ◽  
Nazneen Sultana ◽  
Juber Akhtar
Keyword(s):  
Cancer Therapy ◽  
Liver Cancer ◽  
Treatment Plan ◽  
Chemotherapeutic Drugs ◽  
Drug Delivery Vehicles ◽  
Chronic Hepatitis B Virus ◽  
Anti Cancer ◽  
B Virus ◽  
Delivery Vehicles ◽  
Liquid Dosage Form

Cancer is a leading cause of mortality worldwide, accounting for 8.8 million deaths in 2015. Among these, at least 0.78 million people died of liver cancer alone. The recognized risk factors for liver cancer include chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, exposure to dietary aflatoxin, fatty liver disease, alcohol-induced cirrhosis, obesity, smoking, diabetes, and iron overload. The treatment plan for early diagnosed patients includes radiation therapy, tumour ablation, surgery, immunotherapy, and chemotherapy. Some sort of drug delivery vehicles has to be used when the treatment plan is targeted chemotherapy. Nanoemulsions are a class of biphasic liquid dosage form which are mixtures of oil and water stabilized by a surfactant. They are either transparent or bluish in hue and serve as a wonderful carrier system for chemotherapeutic drugs. These vehicles have a particle size in the range of 20-200 nm allowing them to be delivered successfully in the deepest of tissues. Recent publications on nanoemulsions reveal their acceptance and a popular choice for delivering both synthetic and herbal drugs to the liver. This work focuses on some anti-cancer agents that utilized the advantages of nanoemulsion for liver cancer therapy.

scholarly journals Sacral neuromodulation implanted patients: Patient concerns during the COVID-19 pandemic and practical modifications

2021 ◽  
Vol 13 ◽  
pp. 175628722199813
Author(s):  
Mai Ahmed Banakhar
Keyword(s):  
Sacral Neuromodulation ◽  
Arabic Language ◽  
Web Based ◽  
Economic Changes ◽  
Continuous Care ◽  
Urinary Tract Symptoms ◽  
Great Solution ◽  
Telephone Calls ◽  
Patient Concerns

Objective: To study the effect of the COVID-19 pandemic on sacral neuromodulation (SNM) implanted patients and examine patient concerns. Methodology: A web-based survey was sent to all SNM patients, including those with implants and who had a cancelled operation because of the pandemic. The survey consisted of 15 questions in Arabic language, which sought to evaluate outcomes, as well as patient concerns and preferences during the COVID-19 pandemic. Results: A total of 66 patients were contacted, and of which, 62 replied. Most of the patients ( n = 51; 82.3%) had the device implanted, and 11 (17.7%) patients had a postponed operation secondary to the pandemic. There were 20 males and 42 females. The mean age was 34 years ± SD 16.5 (9–62 years). Indications for sacral neuromodulation therapy were refractory overactive bladder OAB 35 (56.5%), retention 17 (27.4%), OAB + retention 3 (4.8%). When questioning the effect of the lockdown on patients, most reported no effect (43.5%), while 14.5% had some programming difficulties. The patients preferred telephone calls for device emergencies and clinic follow-up with 88.7% and 98.4%, respectively. Most patients had no concerns regarding their Interstim device during the pandemic and found it manageable; 8.1% had insurance concerns due to the economic changes. Conclusion: Patients with implanted SNM for lower urinary tract symptoms were mainly concerned with device programming. Telemedicine is a great solution for continuous care in this group.

scholarly journals Triaging and adaptations of surveillance of cancer services in the COVID pandemic

2020 ◽  
pp. 1-3
Author(s):  
Shirley Lewis ◽  
Lavanya Gurram ◽  
Umesh Velu ◽  
Krishna Sharan
Keyword(s):  
Cancer Patients ◽  
Clinical Examination ◽  
Cancer Care ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Cancer Services ◽  
Low Middle Income Countries

Abstract Introduction: Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer. Methods: Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients. Conclusions: We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

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