scholarly journals Implementing and Improving Automated Electronic Tumor Molecular Profiling

2016 ◽  
Vol 12 (3) ◽  
pp. e332-e337 ◽  
Author(s):  
Matthew J. Rioth ◽  
David B. Staggs ◽  
Lauren Hackett ◽  
Erich Haberman ◽  
Mike Tod ◽  
...  
Keyword(s):  
Medical Center ◽  
Data Entry ◽  
Molecular Profiling ◽  
Third Party ◽  
Genomic Testing ◽  
Transmission Errors ◽  
Electronic Reporting ◽  
Plain Paper ◽  
Oncology Practice ◽  
Direct Feedback

Oncology practice increasingly requires the use of molecular profiling of tumors to inform the use of targeted therapeutics. However, many oncologists use third-party laboratories to perform tumor genomic testing, and these laboratories may not have electronic interfaces with the provider’s electronic medical record (EMR) system. The resultant reporting mechanisms, such as plain-paper faxing, can reduce report fidelity, slow down reporting procedures for a physician’s practice, and make reports less accessible. Vanderbilt University Medical Center and its genomic laboratory testing partner have collaborated to create an automated electronic reporting system that incorporates genetic testing results directly into the clinical EMR. This system was iteratively tested, and causes of failure were discovered and addressed. Most errors were attributable to data entry or typographical errors that made reports unable to be linked to the correct patient in the EMR. By providing direct feedback to providers, we were able to significantly decrease the rate of transmission errors (from 6.29% to 3.84%; P < .001). The results and lessons of 1 year of using the system and transmitting 832 tumor genomic testing reports are reported.

Physician inter-annotator agreement in the Quality Oncology Practice Initiative (QOPI) manual abstraction task.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 226-226
Author(s):  
Jeremy Warner ◽  
Reed Drews
Keyword(s):  
Research Training ◽  
Medical Center ◽  
Human Subjects ◽  
Data Entry ◽  
Interquartile Range ◽  
Accuracy Measurement ◽  
Non Hodgkin Lymphoma ◽  
Oncology Practice ◽  
Data Elements ◽  
No Gold Standard

226 Background: The Quality Oncology Practice Initiative (QOPI) relies upon the accuracy of manual abstraction of clinical data from paper-based and electronic medical records (EMR’s). While there is no “gold standard” to measure manual abstraction accuracy, measurement of inter-annotator agreement (IAA) is a commonly agreed-upon surrogate. We quantified the IAA of QOPI abstractions on a cohort of cancer patients treated at Beth Israel Deaconess Medical Center. Methods: The EMR charts of 49 patients (20 colorectal cancer; 18 breast cancer; 11 non-Hodgkin lymphoma) were abstracted by separate physician abstractors in the Fall 2010 and Fall 2011 QOPI abstraction rounds. The Fall 2011 abstractors were unaware that the charts had been previously abstracted. We analyzed data elements that were common to both rounds, had data entry for both rounds, and did not contain information expected to change after the Fall 2010 round. Cohen’s kappa (κ) was calculated for encoded data; raw levels of agreement and magnitude of discrepancies were calculated for numeric and dated data. IRB approval was obtained and all investigators completed appropriate human subjects research training. Results: 109 data elements with 2,035 paired entries met the above criteria; four narrative elements were not analyzed. Overall IAA for 1,496 coded entries was κ=0.75; median IAA for n=85 individual coded elements was κ=0.84 (interquartile range 0.30-1.00). Overall IAA for 421 dated entries was 73%; median IAA for n=17 individual dated elements was 67% (interquartile range 61-86%). The median discrepancy for the 113 discrepant dated entries was +6 days (range -217 to +391 days). Conclusions: This study establishes a baseline level of accuracy for a complex medical abstraction task with clear relevance for the oncology community. Despite the fact that all information was available in the EMR, there was disagreement for objective elements (e.g. cancer stage) as well as subjective elements (e.g. patient wellbeing). Given that the observed κ is considered only fair IAA, and that the rate of date discrepancy is high, caution is necessary in interpreting the results of QOPI and other manual abstractions of clinical oncology data.

Characteristics and risk factors associated with stroke subtypes among adult patients admitted to stroke unit of JUMC

2019 ◽  
Vol 15 ◽  
Author(s):  
Bekalu Getachew Gebreegziabher ◽  
Tesema Etefa Birhanu ◽  
Diriba Dereje Olana ◽  
Behailu Terefe Tesfaye
Keyword(s):  
Risk Factors ◽  
Stroke Unit ◽  
Medical Center ◽  
Data Entry ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Factors Associated ◽  
Stroke Subtypes

Background: Stroke is a great public health problem in Ethiopia. According to reports, in-hospital stroke mortality was estimated to be 14.7% in Ethiopia. Despite this, in this country researches done on factors associated with stroke sub-types were inadequate. Objective: To assess the Characteristics and risk factors associated with stroke sub-types among patients admitted to JUMC. Methods and materials: A retrospective cross sectional study was conducted from May 2017 to May 2018 in stroke unit of Jimma University Medical Center. A total of 106 medical charts of patients diagnosed with stroke were reviewed. Checklist comprising of relevant variables was used to collect data. SPSS version 21 was employed for data entry and analysis. Chi-square test was used to point-out association and difference among stroke sub-types. The data was presented using text, tables and figures. Result: From a total of 106 patients, 67(63.2%) were men. The mean ± SD of age was 52.67±12.46 years, and no significant association was found. Of all the patients, 59(55.6%) had ischemic strokes and 47(44.4%) had hemorrhagic strokes. The most common risk factor in the patients was alcohol use with a prevalence of 69.9%. Of all the risk factors, only sex, cigarettes smoking and dyslipidemia were significantly associated to sub-types of stroke. Conclusion: Ischemic stroke was the most common subtype of stroke. Sex of patient, cigarette smoking and dyslipidemia are significantly associated with the two stroke subtypes.

scholarly journals EPEN-45. NORMALIZING AND FACILITATING GENOMIC TESTING AT DIAGNOSIS IN PEDIATRIC EPENDYMOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii317-iii317
Author(s):  
Emily Owens Pickle ◽  
Ana Aguilar-Bonilla ◽  
Amy Smith
Keyword(s):  
Current Practice ◽  
Molecular Classification ◽  
Molecular Data ◽  
Molecular Profiling ◽  
Genomic Testing ◽  
Molecular Testing ◽  
Newly Diagnosed ◽  
Pediatric Ependymoma ◽  
Need Support ◽  
Almost All

Abstract The current consensus is that diagnosis and treatment of ependymoma should be based upon clinical and molecular classification. As we move into this paradigm, it is important all ependymoma cases undergo tumor collection, preservation, and molecular profiling at diagnosis. Our group of 6 sites gathered data on a cohort of 72 ependymoma cases. Sites were asked to report known molecular findings; 60/68 eligible cases (88%) did not include genetic findings. The low number of cases with molecular findings was surprising and since cases were diagnosed from as early as 2004, we asked collaborators to share their current practice in profiling (e.g., how frequently; in what setting were ependymomas sent for testing) to try and better understand current practice at sites. Since the publication of ependymoma molecular data, sites with a neuro-oncology program report sending almost all newly diagnosed ependymomas for molecular testing, whereas current practices at sites without dedicated neuro-oncology were less consistent. Profiling in the setting of relapse was more frequently reported at all centers. The implementation of molecular testing at diagnosis may need support at sites without dedicated neuro-oncology. Lead investigators for upcoming ependymoma clinical trials will need to think carefully about the logistics of profiling at centers where this is not standard practice at diagnosis.

A comparison of response in the presence or absence of a delay in induction therapy with bortezomib, lenalidomide, and dexamethasone

2018 ◽  
Vol 25 (7) ◽  
pp. 1692-1698 ◽  
Author(s):  
Allison J Schepers ◽  
Alexis R Jones ◽  
Brandi N Reeves ◽  
Sascha A Tuchman ◽  
Jill S Bates
Keyword(s):  
Induction Therapy ◽  
Response Rate ◽  
Medical Center ◽  
Reproductive Potential ◽  
The United States ◽  
Delay Group ◽  
Primary Objective ◽  
Third Party ◽  
Mean Delay ◽  
Risk Patients

Purpose Lenalidomide, bortezomib, and dexamethasone (RVd) has emerged as a preferred induction therapy in multiple myeloma (MM) in the United States. Due to lenalidomide's teratogenic risk, patients and prescribers must comply with a risk evaluation and mitigation strategy (REMS) program. The REMS program limits dispensing to certain third-party specialty pharmacies, whose average prescription fill times are longer than in-house specialty pharmacies. In practice, a delay in procurement of lenalidomide may mean that patients start therapy with only bortezomib and dexamethasone, delaying the start of more effective triplet therapy. The primary objective of this study is to determine if a delay from start of bortezomib and dexamethasone to start of triplet therapy with lenalidomide impacts rate of achievement of very good partial response (VGPR) after four cycles of RVd. Methods This was a single-center retrospective review of adults with newly diagnosed MM who received RVd induction therapy at University of North Carolina Medical Center between April 2014 and June 2017. Patients who started lenalidomide ≥10 days after bortezomib comprised the “Delay” group, while those who started lenalidomide concurrently with bortezomib or within 1–9 days after bortezomib comprised the “No Delay” group. The primary outcome was VGPR or better response rate after four cycles of RVd. Results Thirty-eight patients met inclusion criteria. Nine patients (23.7%) experienced any delay in initiation of lenalidomide, with a mean delay of 7.8 days (range 1–18). Four patients (10.5%) experienced a delay ≥10 days. No patients in the Delay group were of reproductive potential, compared to 8.8% in the No Delay group ( p = 0.54). VGPR or better response rate did not differ between the Delay and No Delay groups (66.7% vs. 58.8%, p = 0.79). The mean number of lenalidomide prescriptions generated per RVd cycle was 1.35 (range 1–5, SD 0.74). Conclusions This study did not demonstrate an effect on clinical response after delays ≥10 days between bortezomib and lenalidomide initiation. No patients in the delay group were females of reproductive potential, which is the primary target for increased safety behind the REMS program.

scholarly journals A 5 Year Retrospective Analysis of Leave against Advice from the Medical Wards of a Nigerian Tertiary Hospital

2020 ◽  
pp. 351-356
Author(s):  
JE Ojobi ◽  
E Ugwu ◽  
PO Idoko ◽  
MO Ogiator ◽  
SS Gomerep ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Hospital ◽  
Third Party ◽  
Hospital Environment ◽  
Clinical Event ◽  
Health Care Administrators ◽  
Voluntary Consent ◽  
Adverse Clinical Event ◽  
Medical Wards ◽  
Attending Physician

Self discharge (SD) of hospitalized patients is an adverse clinical event often resulting from a fundamental disagreement between the patient or an interested third party and the attending physician and / or the hospital environment. This culminates in the patient’s withdrawal of their initial voluntary consent for hospitalisation and abrupt termination of in - patient medical care. Patients who left hospital admission against the advice of their doctors are both a concern and a challenge for individuals in the health industry. It negatively impacts treatment outcomes and exposes the clinician and health care administrators to the hazards of litigations. The study was aimed at determining the incidence of SD and associated factors in medical admissions. It was a retrospective descriptive hospital based study of patients who self discharged from medical wards of Federal Medical Center, Makurdi from June 2012 – May 2017. Approval was obtained from the institution’s research ethics board. Thirty one individuals (0.62% of total admission) self discharged within the study period. Financial constraints was responsible for 32.2% (10) of SD followed by proximity to social support 19.4% (6). Five patients (16.1%) elected not to disclose any reasons. The incidence reduced from 0.21% to 0.02% at the start and end of study period respectively. Though SD was relatively low in this study, the incidence could be reduced further by expanding the scope of health insurance scheme, skilful communication and negotiating patient management using patient – centred methods.

scholarly journals A patient and family reporting system for perceived ambulatory note mistakes: experience at 3 U.S. healthcare centers

2019 ◽  
Vol 26 (12) ◽  
pp. 1566-1573 ◽  
Author(s):  
Fabienne C Bourgeois ◽  
Alan Fossa ◽  
Macda Gerard ◽  
Marion E Davis ◽  
Yhenneko J Taylor ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Relevance ◽  
Potential Role ◽  
Reporting System ◽  
Medical Center ◽  
Descriptive Statistics ◽  
Medical Problems ◽  
Electronic Reporting ◽  
Reporting Systems

Abstract Objective The study sought to test a patient and family online reporting system for perceived ambulatory visit note inaccuracies. Materials and Methods We implemented a patient and family electronic reporting system at 3 U.S. healthcare centers: a northeast urban academic adult medical center (AD), a northeast urban academic pediatric medical center (PED), and a southeast nonprofit hospital network (NET). Patients and families reported potential documentation inaccuracies after reading primary care and subspecialty visit notes. Results were characterized using descriptive statistics and coded for clinical relevance. Results We received 1440 patient and family reports (780 AD, 402 PED, and 258 NET), and 27% of the reports identified a potential inaccuracy (25% AD, 35% PED, 28% NET). Among these, patients and families indicated that the potential inaccuracy was important or very important in 58% of reports (55% AD, 55% PED, 71% NET). The most common types of potential inaccuracies included description of symptoms (21%), past medical problems (21%), medications (18%), and important information that was missing (15%). Most patient- and family-reported inaccuracies resulted in a change to care or to the medical record (55% AD, 67% PED, data not available at NET). Discussion About one-quarter of patients and families using an online reporting system identified potential documentation inaccuracies in visit notes and more than half were considered important by patients and clinicians, underscoring the potential role of patients and families as ambulatory safety partners. Conclusions Partnering with patients and families to obtain reports on inaccuracies in visit notes may contribute to safer care. Mechanisms to encourage greater use of patient and family reporting systems are needed.

Features of Failed Genomic Testing in Advanced NSCLC Specimens

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S147-S148
Author(s):  
E M Gardner ◽  
W Li ◽  
M B Cohen ◽  
U Topaloglu ◽  
S Ramkissoon
Keyword(s):  
Lung Cancer ◽  
Medical Center ◽  
The United States ◽  
Tumor Location ◽  
Advanced Lung Cancer ◽  
Genomic Testing ◽  
Error Type ◽  
Common Features ◽  
Test Standards ◽  
Genomic Test

Abstract Introduction/Objective Lung cancer continues to be the leading cause of cancer death in the United States. For individuals with advanced lung cancer, genomic testing has the potential to direct patients and their care teams toward a targeted therapy or a specific clinical trial. In some instances, however, submitted specimens fail to meet test standards or do not survive the analytic process. The implications of a failed genomic test for patients can be grave. In this study, we aim to identify common features among non-small cell lung cancer (NSCLC) samples submitted from our medical center that failed FoundationOne testing (Foundation Medicine Inc. Cambridge, MA). Methods From all 366 NSCLC samples listed in the FoundationOne database, we identified 31 (8.5%) unique and accessible accession numbers submitted from our institution that failed processing between 2013-2018. These 31 samples were compared for common features, including NSCLC subtype, tumor location, sampling method, tumor size, submitting team, and reported error type. Results From all of our samples, 45% (14/31) were adenocarcinoma, 29% (9/31) were squamous cell carcinoma (SCC), 22% (7/31) were NSCLC otherwise unspecified, and 3% (1/31) was adenoid cystic carcinoma. The majority of samples (20/31) were sampled from primary sites including core biopsies (n=9), FNA (n=5), lobectomy specimens (n=4), and bronchial washings (n=2). The remaining metastatic samples came from sites including lymph node, bone, brain, and adrenal gland. Per FoundationOne: the majority of samples (27, 87%) failed following sequencing, while the remaining four (4, 13%) samples failed in the analytic phase. Conclusion At this time, it remains unclear why many of these samples failed sequencing. Our next steps include comparing the degree of necrosis from samples and comparing our failed sample pool to a successful sample pool of equal size to remove potential confounding factors.

A cost analysis of practicing oncology via telemedicine

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6143-6143
Author(s):  
G. C. Doolittle ◽  
A. O. Spaulding ◽  
A. R. Williams
Keyword(s):  
Average Cost ◽  
Administrative Support ◽  
Medical Center ◽  
Substantial Reduction ◽  
Fiscal Year ◽  
Traditional Practice ◽  
Efficient Alternative ◽  
Cost Efficient ◽  
Oncology Practice ◽  
The University

6143 Background: The University of Kansas Medical Center (KUMC) has offered oncology services via interactive tele-video (ITV) to patients in rural Kansas for over a decade. A KUMC oncologist utilizes ITV technology to connect with patients at Hays Medical Center (HMC), which is approximately 265 west of KUMC. The technology enables the oncologist to conduct a complete patient visit without being in physical proximity to the patient. To date, two cost-tracking studies have been conducted to determine expenses associated with the tele-oncology practice. A third study recently analyzed costs incurred during fiscal year 2005 (FY05). Methods: In order to determine the costs of the practice during FY05, HMC and KUMC expenses were monitored for oncology services rendered via telemedicine. An analysis revealed expenses common to a traditional oncology practice and additional expenses unique to a telemedicine practice. Administrative support staff salaries, the oncologist’s contract fees, and nursing staff salaries made up the majority of the traditional practice-related expenses. Costs unique to a tele-oncology practice were those associated with technology including expenses for telemedicine equipment, telecommunication charges, and technician time. Results: Expenses for the tele-oncology practice on the KUMC side totaled $22,848, with $7,331 attributed to technology-related costs and $15,517 attributed to practice-related costs. For HMC, $5,803 in technology-related costs and $30,430 in practice-related costs totaled $36,233. At 235 tele-oncology consults and a combined total expense of $59,081 between KUMC and HMC, the FY05 analysis resulted in an average cost of $251 per consult. When compared to prior studies, this shows a substantial reduction in costs related to the practice of telemedicine. Conclusions: The average cost of a tele-oncology visit in Kansas has consistently decreased significantly since the practice’s 1995 inception. Analyses have revealed that the costs of providing oncology services via telemedicine are closely tied to utilization, as the majority of the expenses are related to personnel rather than technology. Telemedicine has proven itself to be a cost-efficient alternative to offering regular outreach clinics. No significant financial relationships to disclose.

Assessing real-world outcomes in precision oncology by linking clinical genomic testing to electronic medical records.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18091-e18091
Author(s):  
Debajyoti Datta ◽  
Theodore Goldstein ◽  
Atul Butte
Keyword(s):  
Next Generation Sequencing ◽  
Cancer Patients ◽  
Relational Database ◽  
Real World ◽  
Molecular Profiling ◽  
Genomic Testing ◽  
Precision Oncology ◽  
Clinical Sequencing ◽  
Clinical Genomic ◽  
Generation Sequencing

e18091 Background: With an ever-widening array of targeted therapies for cancer patients, clinical genomic testing has expanded rapidly in recent years. Tumor molecular profiling by next-generation sequencing is now considered a cornerstone of precision oncology, with the potential to offer patients with advanced cancers new therapeutic options. However, the overall impact of this testing remains unclear, and evidence demonstrating improvement in patient outcomes is lacking. The objective of this study is to assess the utility of clinical sequencing on the management of cancer patients. Methods: We present the development of a database that combines results of tumor mutation profiling using various next-generation sequencing panels (both external commercial tests and our institution’s internal sequencing panel), with a variety of data points from a de-identified representation of our institution’s electronic medical record (EMR). Assembling this data from different sources into a common relational database permits efficient retrospective analysis of real-world outcomes in patients with advanced cancers. Results: This study included over 3000 patients seen at UCSF Comprehensive Cancer Center since 2013. With this linked data set we analyzed the rate at which tumor molecular profiling affected clinical decision making, identified barriers to the efficient use of testing, and assessed for disparities in utilization. For example, by measuring patient survival relative to the clinical intervention of genomic testing for the subset of patients with a date of death recorded in our EMR, we found that a small fraction of patients died before results returned and any action could be taken, especially in cases of pancreatic cancer. Conclusions: We demonstrate that a common relational database combining clinical sequencing results with real-world EMR data provides insights into the optimal clinical use of tumor molecular profiling. This provides new opportunities for advancing precision oncology initiatives and improving patient care, such as identifying which cancer patients should get genomic testing and efficiently matching patients to clinical trials.

Oral chemotherapy education: Hitting the mark?

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 221-221
Author(s):  
Jonathan L Berry ◽  
Jim W Doolin ◽  
Garrett Diltz ◽  
Tenzin Dechen ◽  
Natalia Forbath ◽  
...  
Keyword(s):  
Formal Education ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hematologic Malignancies ◽  
Oral Chemotherapy ◽  
Community Practice ◽  
Medication Persistence ◽  
Process Measures ◽  
Education Group ◽  
Oncology Practice

221 Background: ASCO’s Quality Oncology Practice Initiative (QOPI) includes process measures on oral chemotherapy education. Whether achievement of these measures has an impact on clinical outcomes and if an intervention to improve these measures can improve outcomes is not yet known. Methods: A retrospective analysis was conducted of patients initiated on oral chemotherapy in an academic medical center site and a community oncology practice between January 2016 and October 2019. The primary aim was to compare the time to emergency department (ED) within 90 days from initiation of oral chemotherapy of patients who met the QOPI process measure through an intervention of pharmacist-driven education with a comparison group of patients who had not received formal education. A secondary aim was to assess for a difference in oral chemotherapy medication persistence. Data were also analyzed by demographics, concurrent parenteral therapy, intent of therapy, and disease group. Results: 285 patients in the education group and 284 patients in the non-education group were analyzed. The education group had a higher proportion of patients with gastrointestinal and gynecologic cancers, and a lower proportion of patients with hematologic malignancies, compared to the non-education group. The education group also had a higher proportion of patients treated at the community practice compared to the non-education group. There was no statistical difference in median time-to-ED, with 49 days (IQR 37-74) in the education group and 59 days (IQR 41-60) in the non-education group (p=0.15). Conclusions: In patients receiving oral chemotherapy, pharmacist-driven education with improvement in QOPI process measures did not result in an improvement in time to ED. One factor contributing to this result may be that only 20% of patients required ED-level care within 90 days of starting oral We continue to collect data regarding medication persistence, which may be a more sensitive outcome measure. At this point, further work is needed to determine if achievement or modification of the QOPI oral chemotherapy process measures results in a clinically significant change in outcome. [Table: see text]

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