SCN Medical Oncology Wait Time Project
Goal
The health goal for this project is to improve the Medical Oncology service delivery and reduce wait times for cancer patients.
Purpose
The purpose of this project is to support the South Island Cancer Centres in the collection of the Wait Times data by enabling the information to be recorded within the daily workflow and provide a system from which it can be readily reported to the ministry.
The project presents a multifaceted approach with three integrated workstreams:
1. Collecting of and reporting on Medical Oncology Wait Times.
2. Development and implementation of a core set of Medical Oncology chemotherapy prescriptions and e-prescribing for the South Island within MOSAIQ
3. Integrated referral system.
Rationale
DHB Chief Executives were advised by the Cancer Control Steering Group (CCSG) at their meeting on 16 April 2010 to use the Medical Oncology Prioritisation Criteria as a basis for Medical Oncology prioritisation from 1 July 2010.
The criteria determine access to publically funded Medical Oncology services in New Zealand and also support DHB achievement of the Service Coverage requirements for Medical Oncology outlined in the 2011/12 Service Coverage Schedule (page 82) and DHB achievement of the draft Policy Priority: Waiting Times for Chemotherapy Treatment as outlined in the draft DHB Non-Financial Monitoring Framework 2011/12.
Furthermore, the criteria will also serve to inform the future development of cancer waiting times indicators and/or targets.
In order to assist the DHBs with the implementation of the criteria, the MoH had requested submission of proposals to address four areas targeted by the Cancer Programme:
1. “developing and updating reporting systems to collect and report waiting times for Medical Oncology services as recommended in the Medical Oncology Prioritisation Criteria”
2. “supporting initiatives that allow better patient management and also increase flexibility in managing referrals, scheduling appointments and co-ordinating workflows”
3. “streamlining of workflow and processes from the First Specialist Assessment (FSA) to start of treatment to ensure patients start treatment within four weeks”.
4. “strategies for recruiting and retaining key Medical Oncology treatment workforce, including pharmacists, nursing and medical staff.”
In collaboration with the Clinical Directors of the two public cancer centres of the South Island, the Southern Cancer Network submitted a proposal to the Ministry of Health and were approved funding for the SCN Medical Oncology Wait Times project.
This project addresses the first three of the four areas targeted by the Cancer Programme.
Process
The project consists of three distinct work streams, which together will contribute to the overall goal of reducing medical oncology wait times. An advisory group has been formed to ensure guidance and leadership to each work stream, and to facilitate the completion of the work items.
Work stream 1: Collecting of and reporting on Medical Oncology Wait Times
1A Description of current mechanisms for collecting Medical Oncology Wait Times Data
The different mechanisms that are currently in place across the South Island for collecting and reporting on the Wait Times are collected and described.
1B Define data items
Clear definitions of the data items that need to be collected to measure Medical Oncology Wait Times are to be developed and agreed across the South Island. This work will leverage on and contribute to the concurrent development of the South Island Clinical Cancer Information System (SICCIS).
1C Support implementation of systems to electronically collect Wait Time Data
To facilitate the capture of the agreed wait time data items via the Medical Oncology software MOSAIQ which is scheduled to be implemented in the Christchurch and Dunedin Cancer Centres at the end of 2011 or start of 2012. An expert user/data manager will be available on a fixed-term basis to provide implementation and system change support in each of the two cancer centres.
Work stream 2: Development and implementation of a core set of Medical Oncology chemotherapy prescriptions and e-prescribing for the South Island within MOSAIQ
2A Developing a core set of consistent Medical Oncology Chemotherapy prescriptions
Collection of all Medical Oncology chemotherapy prescriptions that are used on the South Island and development of a core set that can be accessed electronically via MOSAIQ, with the goal to enable e-prescriptions to be generated from within the same platform.
This will also enable reporting on the therapeutic agents used within those chemotherapy prescriptions.
2B Supporting implementation of e-prescribing
Supporting implementation of e-prescribing by
(i) ensuring functionality of the e-prescribing module within the MOSAIQ software,
(ii) collaboration with Health Legal to allow utilisation of the e-prescribing module in NZ, for example via dispensation for electronic signatures,
(iii) integrating e-prescribing into the workflow, and
(iv) facilitating linkages with other e-prescribing systems, such as MedChart, and other third party repositories of patient data, such as SYSMEX.
2C Alignment of Medical Oncology chemotherapy prescriptions
Alignment of Medical Oncology chemotherapy prescriptions will identify redundancies in the core set of Medical Oncology Chemotherapy prescriptions and develop a core set that is consistent across the South Island.
Work stream 3: Integrated referral system
3A Incorporating MDM information into MOSAIQ
Develop processes to ensure MDM information is captured in the MOSAIQ software.
3B Supporting MDM as primary referral platform
Utilisation of multidisciplinary team meeting (MDM) template to design and develop electronic referral processes using the HISO online form standard and national data concepts for cancer and primary care, as well as the configuration of MOSAIQ to receive and send the New Zealand standard of HL7 Referral, Status, and Discharge messages.
3C Integrating internal referrals
Support of developing electronic referrals that originate internally, but outside of MDMs, and integration of these into the MOSAIQ system.
3D Integrating external referrals
Support of the development of a platform for external electronic referrals that can be received by the MOSAIQ system. Focus will be on referral pathways for the national tumour streams lung and bowel, followed by other tumour streams (breast, prostate and other) and generic referrals.
The approach is to integrate the pathway into the HISO online forms so that the GP user can navigate between pathways and referral forms within the Electronic Medical Record, and with work currently occurring in CDHB on Health pathways and towards electronic referrals.
