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Announcements, Introductions, & Updates

caBIG ® Clinical Information Suite West Michigan Cancer Center Domain Expert Meeting Oct 27-28, 2010. Announcements, Introductions, & Updates. Wednesday, October 27, 2010. Announcements, Introductions, and Updates. Topic Agenda Wednesday October 27 . Topic Agenda Thursday October 28 .

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Announcements, Introductions, & Updates

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  1. caBIG® Clinical Information SuiteWest Michigan Cancer CenterDomain Expert Meeting Oct 27-28, 2010

  2. Announcements, Introductions, & Updates Wednesday, October 27, 2010 Announcements, Introductions, and Updates

  3. Topic Agenda Wednesday October 27

  4. Topic Agenda Thursday October 28

  5. caBIG Clinical Information Suite – Therapeutics Chemotherapy Management

  6. caBIG Clinical Information Suite Domain Analysis Model

  7. DAM Changes Review • Outcomes Models • Encounter • Changes to Treatment Plan • Concerns • Allergies • Cancer

  8. Outcomes

  9. Encounter

  10. Treatment Plan

  11. Concern (Problem List)

  12. Allergies

  13. Cancer Concerns

  14. Modeling Chemotherapy Activities • There are three activities normally associated with an administration activity: • The Order • The Supply • The actual Administration • “Normal” prescriptions make the order and supply explicit but the administration is implicit and assumed. • We assume because you picked up your Crestor that you are actually taking it as told • Immunizations have an explicit administration with an implicit supply, but not very often an order • We have international use cases for an immunization order • Chemotherapy? • My first guess: an Order and an Administration with an implicit supply

  15. caBIG Clinical Information Suite – Diagnostics Cancer Staging

  16. Cancer Staging Discussion • AJCC 7th Edition 1. ‘Staging Group’ = ‘Anatomic Stage/Prognostic Groups’ • Anatomic Stage (Stage IIIB) • Prognostic Factors (HER2 status . . .) 2. Subtle but important changes on rules! 3. EHR cancer staging vs. Cancer Registry • Summary Staging? 4. Generalization back to Breast Cancer model

  17. AJCC 7th • Some changes in TNM • Changes in terminology (6th Staging Group, in 7th is Anatomic Stage/Prognostic Group)

  18. Breast Cancer Example AJCC 7th Edition

  19. Anything missing? • Method used for staging (clinical vs. pathologic) • Histologic is pathologic, not clinical • Imaging stuff is clinical, not pathologic • Not consistent which has more information • Both will be recorded • Laterality – where would it come from? (ICD-9-CM); quadrant on breast seems to be important for billing, as well as proximity to nipple; does not actually affect actual stage • With neo-adj, may get pathology after chemo • ypT, ypM, ypN

  20. Need a “field” for “Mitotic rate” • Duke (for colorectal)? Don’t support using? • Siewert? Sounds like it is used to figure out which body site to use for AJCC • Need a capability to add new staging systems in the future, but it needs to have controls to prevent tweaking AJCC • How to model current RI to support such future extension?

  21. Disease/Stage Systems that fit the same model

  22. All sarcomas use “grade” in staging • Gyno has FIGO, but it’s been mapped to AJCC • Substaging for various areas, but still AJCC • Gestational trophoblastic tumors are not staged exactly the same way as other areas, as the relay on some clinical lab results; also age, antecedant pregnancy, others • Whitmore-Jewitt is Bladder (very old?); use AJCC • CNS – Glioma has no staging (diffused or focal); some have WHO system (grade 1-4); rely on pathology report, other standard reports • Genetic markers? Not ready to go there • Lymphoma - there are masses that can be measured, as well as liquid; TNM doesn’t work the same (you don’t use it); AJCC has taken over Ann Arbor staging system (A and B) • IPI – Int’l Prognostic Indicator

  23. Leukemia – non-solid (skip)\ • Present DE group don’t practice pediatric oncology • Will look at vetting with larger SEG group • St. Judes may be a good contact

  24. Cancer Staging Discussion • Source report traceability– expand on topic • What would be useful? • As long a particular document or image can be selected to link back to staging data (possibly T,M, or N separately), that would be ideal • Reporting needs • Report to problem list • Auto-populate in notes • Referrals • Scope statement document in progress

  25. Topic: “restaging” • AJCC 7th supports a restaging concept with “r” prefix (cancer returns after disease-free state); will this really be used? Not sounding like it, would be fine with an indicator • Other issue: disease progresses (i.e., spreading to other organs/sites)

  26. caBIG Clinical Information Suite – Therapeutics Chemotherapy Management

  27. Next Steps? • Planning for next steps • Questions? • Big Thank you!

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