Domain Expert Working Session

1. Domain Expert Working Session October 27-28, 2010

2. caBIG Clinical Information Suite CHEMOTHERAPY MANAGEMENT

3. Overview • Chemotherapy Management • Chemotherapy Template Management • Chemotherapy Planning • Medication Ordering • Non-medication Ordering • Chemotherapy Scheduling • Chemotherapy Administration

4. Chemotherapy Template Management • Current State • No standard for content in a chemotherapy template • Identifying templates a highly variable process from practice to practice • Future state • Have a standard for content that allows downloading, sharing, and auto-populating treatment plans, order set templates, orders, flow sheets and patient education • Ensure that identifying templates based on patient diagnosis, cancer group, drug name, or template name is easy to use

5. Chemotherapy Planning • Current State • Planning is highly manual overall • Placing information from templates into plans primarily occurs manually • Locating clinical trials not consistently integrated in the planning process • Future State • Automate portions of planning, such as contraindications and insurance eligibility • Automate population of treatment plans from templates, while remaining flexible • Integrate clinical trial search in process

6. Medication Ordering • Current State • Lack of automation can lead to dosing errors • Electronic ordering does not consistently support use of order sets • Medication orders may get split out at the dispensing location • Future State • Automation will help reduce dosing errors • Chemotherapy orders can be handled electronically as part of order sets • Medication orders remain integrated to ensure order sets are appropriately addressed

7. Non-Medication Ordering • Current State • To Be Determined • Assumption: Computerized support inconsistent • Assumption: Integration with medication orders in order sets and flow sheets not consistent • Future State • Non-medication ordering will have automated support, such as alerts and edits • Non-medication orders will be integrated with medication and other orders in order sets and flow sheets

8. Chemotherapy Scheduling • Current State • Requires labor-intensive coordination for multi-disciplinary care plans • Integration into flow sheets may be inconsistent • Future State • Scheduling will integrate information from multiple treatment plans, staffing, and resources to provide a dynamic, un-conflicted schedule • All scheduled activities can be consistently integrated into flow sheets

9. Chemotherapy Administration • Current State • Automation of administration instructions from templates is inconsistent • Integration of medication administration information into electronic records and flow sheets is inconsistent • Future State • Instructions will be auto-populated from templates when available • Medication administration records will be directly integrated into electronic records and flow sheets

10. Chemotherapy Management • Current State • Multiple incompatible administrative and clinical systems are used alongside a variety of manual processes to accomplish chemotherapy and related activities, leading to inefficiencies and errors • Information from one step in chemotherapy must be recreated or copied and pasted to support the next step • The results from treating patients does not consistently result in informing the treatment of new patients

11. Chemotherapy Management • Future State • Administrative and clinical systems interoperate based on standards and clinical activities are supported through an integrated user interface, improving efficiency and quality • Appropriate information will flow automatically from the template and planning process throughout the episode care • Treatment results will be available electronically for integration into improved protocols and treatment plans.

12. Future State Vision