ASCO Focuses on Increasing the Capacity to Share Information Across Digital Systems
The norm for many cancer patients today, including those obtaining most of their care in urban settings, is that competing hospital systems do not have “interoperable” data. This means that providers, even when using the same electronic health records platform, do not have the ability to share information across different clinical systems.
The following vignette illustrates the problems that arise when providers cannot share electronic health records with one another:
A diabetic man has just been diagnosed with early-stage colon cancer. Results from laboratory and imaging studies, surgery, family history pedigree, genetic risk assessment, and genomic testing have determined that he will require adjuvant (post-operative) chemotherapy. He has an established relationship with a local primary care physician (PCP) and an endocrinologist, both of whom encourage him to receive adjuvant chemotherapy at a network affiliate 25 miles away. None of the providers share interoperable electronic health records (EHRs). The patient and caregivers are faced with faxing and scanning records; printing out hard copies of records to carry with them to appointments; and accessing multiple physician-supplied patient portals, each with only a slice of the pertinent medical information. The resultant paths of communication are often error-prone and incomplete. The communication problem will only grow worse as the patient enters the survivorship phase, which will last for years to decades.
ASCO’s Efforts to Increase Interoperabiity
Interoperability, the capacity for distinct digital systems to share and reuse information, is paramount to improving the efficiency and coordination of cancer care.
ASCO’s Health Information Technology Work Group (Health IT WG) initiated a new effort in 2012 to begin developing inoperability standards for the transmission of oncology-specific information. These standards will allow any provider, organization, or vendor that uses Meaningful Use-required standards from Health Level Seven International (HL7®) to exchange information. To carry out this effort, ASCO is working with HL7, the leading ANSI-accredited, standards-developing organization focused exclusively on healthcare.
What the New Standards Mean for You as a Provider
ASCO’s new interoperability standard—called the HL7® Clinical Oncology Treatment Plan and Summary (COTPS)—will allow you to extract discrete clinical information and share that information with the patient, specialists on the patient’s care team, the primary care provider, and your cancer registry. To date, ASCO has published two releases of COTPS.
ASCO’s COTPS has several different capabilities and can help your practice in the following ways:
- Enhance communication among the entire care team
- Improve coordination of care, survivorship care, and patient engagement
- Educate primary care providers regarding survivorship guidelines, surveillance, and potential long term effects of treatment
New Standards Demonstrated at the 2015 Annual Meeting
The Clinical Oncology Treatment Plan and Summary (COTPS) allows clinicians to achieve real-time exchange of clinical information. To educate its members about the availability and benefit of using the COTPS, ASCO’s Health Information Work Group (Health IT WG) hosted an Interoperability Demonstration at the 2015 Annual Meeting.
After a competitive recruitment process, twelve teams representing a spectrum of academic health systems, nonprofit, and for-profit vendors, were chosen to demonstrate their interoperability software. During a full day of demonstrations, the teams highlighted their ability to electronically capture, transmit, and utilize clinical cancer information using nationally and internationally recognized interoperability standards.
ASCO has provided a full length video of the Interoperability Demonstration.
A Case-Study Using the COTPS
The event at the 2015 Annual Meeting depicted the hypothetical journey of a patient with colon cancer. The journey started with initial symptoms and went on to include diagnostic work, family history and risk assessment, genomic testing, chemotherapy, and home care. The journey ended with the patient and PCP receiving an electronic copy of ASCO’s Colon Cancer Adjuvant Treatment Plan and Summary document. The demonstration used standards that are currently available.
At each step in the demonstration, one organization played the role of an actor in the journey. The presenters used their own applications, including two different electronic health records, a collaborative care planning system, advanced risk assessment, and chemotherapy order entry.
The Interoperability Demonstration at the 2015 Annual Meeting successfully showed that:
- Coordination of care can be improved by capturing actionable information and sharing it electronically throughout the care team and with the patient.
- Providers can use EHRs to extract cancer-specific information from external databanks not present in current electronic systems.
- Interoperability standards can be implemented in a brief period of time when there is commitment.
- Clinical information can be electronically exchanged between disparate systems that use different architectures and applications.
- Modular applications external to EHRs can be swapped in and out of the oncology software ecosystem as new innovations become available.
- Treatment plans and summaries can be incrementally compiled with information shared among a care team and patient, and generated in full at the end of treatment for the patient and PCP.
Thank you to the participating organizations: 5AM Solutions, Inc., ACT.md, Centers for Disease Control and Prevention, EndoSoft LLC, GenoSpace, Hughes RiskApps with BayesMendel Lab, JBS International, Inc, Lantana Consulting Group, McKesson Specialty Health, mTuitive, Inc., University of Michigan Hospitals and Health Centers with Epic, Vanderbilt University Medical Center.
Thank you to the featured speakers: Peter Paul Yu, MD, FASCO, and Ruth Rechis, PhD.
How to Implement ASCO’s Interoperability Standards in Your Organization
Technical standards are only successful when implemented. However, software vendors are often reluctant to provide frequent new features or updated knowledge without incentives such as national regulations. Even so, many vendors are open to the desires and needs of their users, and this is especially true now that most providers have already installed EHRs and vendors are motivated to retain existing clients.
While the core of the EHR business remains focused on the provision of stable and secure products, practices require innovations to improve workflows and increase the satisfaction of all users. ASCO’s demonstration at the 2015 Annual Meeting showed it was possible to bring interoperability to twelve disparate systems. The demonstration also showed that the various applications from the oncology ecosystem can be swapped with one another as new innovations become available.
To learn more about implementing interoperability standards in your practice, download the free HL7 Clinical Oncology Treatment Plan and Summary Implementation Guide.
What if the COTPS is Currently Not Available in my Vendor’s System?
You can request the Clinical Oncology Treatment Plan and Summary as a product enhancement. As demonstrated by Athena Breast Health Network’s pilot, provider organizations can implement the COTPS if their electronic health record vendor does not provide it (read the JAMIA article to learn more about the design, development, and initial implementation of the COTPS in an integrated delivery network). You may need to consult your vendor for support if you want to implement the COTPS in your organization’s system.
For more information on the COTPS or the Interoperability Demonstration, please contact HealthIT@asco.org.
ASCO to Add Survivorship Care Plan to the COTPS in 2015
In 2015, the Health Information Working Group (IT WG) began a new project transforming ASCO’s new Survivorship Care Plan (SCP), released in 2014, into the COTPS. This project is prioritized for 2015 as a response to two requirements from the Commission on Cancer: One, to provide SCPs for coordination of follow-up and, two, to provide educational information to patients. The Commission on Cancer has endorsed ASCO’s new SCP for including the minimal critical data required for survivorship care.
Read the article in the Journal of Oncology Practice (JOP) for more background on the development of ASCO’s new SCP.