Domain Expert Working Session

1. Domain Expert Working Session December 15, 2010

2. caBIG Clinical Information Suite CHEMOTHERAPYPLANNING

3. Overview • Chemotherapy Planning • Narrative for “Treatment Plan Completed” • Questions • Chemotherapy Template Management • Any changes based on review of requirements? • Medication Administration • High level events review

4. Use Cases / Narratives • Update Chemotherapy Plan • Treatment Plan Completed • Eve Everywoman completes her four cycles of chemotherapy as planned. Dr. Tumor reviews the last post-chemotherapy lab results, radiology images and reports and concludes the treatment goals have been achieved and no additional chemotherapy is needed. • A treatment summary report is prepared for review with Mrs. Everywoman, along with patient education material. Any outstanding financial issues are also noted for discussion.

5. Use Cases / Narratives (cont’d) • Update Chemotherapy Plan (cont’d) • Treatment Plan Completed (cont’d) • Dr. Tumor reviews the treatment summary report and patient education material with Mrs. Everywoman and indicates that the report will be shared with Dr. Carl Cutter in preparation for her surgery. Feedback from Mrs. Everywoman on the experience is collected to potentially improve the experience for subsequent patients. • Dr. Tumor prepares a consult report summarizing the neo-adjuvant chemotherapy treatment provided to Mrs. Everywoman and sends it to Dr. Cutter. A copy is also provided to Mrs. Everywoman.

6. Use Cases / Narratives (cont’d) • Update Chemotherapy Plan (cont’d) • Treatment Plan Completed (cont’d) • Dr. Tumor also prepares a survivorship plan for Mrs. Everywoman that identifies annual appointments for her to be physically and diagnostically examined and long-term symptoms to be aware of that may indicate adverse effects from the chemotherapy. Because the chemotherapy was neoadjuvant, information on cancer recurrence is not provided by Dr. Tumor. • The completed treatment plan is stored away for record-keeping purposes. • The first annual visit from the survivorship plan is scheduled and the plan stored in an appropriate place.

7. Questions • What circumstances result in a decision to place a treatment plan on hold? • Assuming plans are sometimes placed on hold, when are they removed from suspension?

8. Medication Administration • High Level Events (Onsite administration) • Preconditions: Medication(s) have been ordered, the order has gone to the pharmacy, and the pharmacy has confirmed that the orders can be filled according to the instructions in the order set. • Pre-administration diagnostics performed (timing dictated by treatment plan or order set) • Premedications taken (timing dictated by treatment plan or order set)

9. Medication Administration (cont’d) • High Level Events (Onsite administration – cont’d) • Patient arrives for treatment • Patient receives consultation on medications and administration activities (Just first time and if there is a significant change?) • Pretreatment observation or examination of patient • Administration is authorized (Note: this may behave differently with drugs administered multiple times in one day, e.g. IL-2.)

10. Medication Administration (cont’d) • High Level Events (Onsite administration – cont’d) • Medication is prepared (timing is dictated by treatment plan and order set, along information about the stability of the fully prepared medications) • Medication is administered

11. Medication Administration (cont’d) • High Level Events (Onsite administration – cont’d) • Information on the patient taking the medication is recorded (This is intended to be the Medication Administration Record; this may be started at the beginning of the treatment session, with vital signs reading recorded at predetermined intervals, and nurses notes as deemed appropriate; this would also include any post-treatment observation notes) • Monitor Patient Side-Effects (May involve patient self-reporting along with observations during office visits or lab results; assumption is that this is an ongoing activity)