Enhancing Cancer Systemic Therapy Surveillance in Nova Scotia: Development of Quality Indicators and Exploration of a Potential Data Source
Caudle, Christopher J.
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The internship project described in this report was to research indicators and health care quality frameworks as related to cancer systemic therapy. Part of the project was also to explore the potential linkage of data from the Oncology Patient Information System (OPIS) cancer registry with data from the newly implemented MEDITECH Pharmacy Module. The Pharmacy Module is a new system that has been implemented as part of the Nova Scotia Hospital Information System (NShIS). The linkage will allow disease and stage information to be linked with treatment information to produce indicators that will help improve the quality of cancer care. The work was done in the Surveillance and Epidemiology Unit (SEU) of Cancer Care Nova Scotia (CCNS). CCNS is a provincial program of the Nova Scotia Department of Health (NSDOH) and works to coordinate, support, and evaluate cancer services throughout Nova Scotia. The Cape Breton Cancer Centre (CBCC) was also involved as they are a central cancer centre that has already been using the MEDITECH Pharmacy Module for over 18 months. If the linkage works here, it would then be extended to cover the rest of the province. Indicators and health care quality frameworks were researched through a thorough literature review. The review utilized online databases, Internet search engines, websites, and personal communications. In total, about 160 cancer systemic therapy indicators and 13 quality frameworks were found. This will provide an excellent reference and starting point for the selection of systemic therapy indicators to be used in Nova Scotia. The experience also enabled the author to advance his knowledge of approaches to literature reviews. A Canadian environmental scan was completed to gather relevant information from systemic therapy monitoring projects in cancer agencies in other provinces. Valuable information was acquired regarding indicators reported, data sources, and methods of data capture from provinces that have systemic therapy surveillance systems in place. One of the most valuable pieces of information was from a facility that captures systemic therapy data using the same system intended for use in the current project. They had customized the MEDITECH Pharmacy Module to capture regimen drug level information rather than only individual drug information. This will be necessary to report on systemic therapy in meaningful ways. Further investigation of this customization is warranted. This finding illustrated first hand for the author the importance of undertaking an environmental scan. The administrative and technical requirements to perform a linkage of the two datasets were investigated. Because of the respective ownerships of the datasets and privacy issues, permissions will be required from CCNS, DHAs, NSDOH, NShIS, as well as approval from the respective DHA ethics review boards. Technical requirements include extraction of data files from each system and linkage of the two files based on common patient attributes. This would have to be performed by a MEDTECH systems analyst and staff in the CCNS SEU. Specialized software will be used to complete the linkage. The author had the opportunity to view a sample linkage exercise undertaken in the SEU. It could be seen that it is a very useful tool for data integration, which is a common step in the data preprocessing required for many types of data analyses. In anticipation of data extraction and linkage, a set of data variables that would be required from each system was compiled. This was easy to do for the OPIS system as a detailed data dictionary is maintained by CCNS. Such a data dictionary does not exist for the MEDTECH Pharmacy Module, thus a system demo and screenshots were used. Further discussions with a systems analyst and Pharmacy Application Team members will be required to acquire the details necessary to choose which fields are most appropriate for the creation of indicators and to perform the data linkage. This illustrates the concept of tacit knowledge and the difficulty in acquiring knowledge that exists only in the minds of experts. It is recommended that a data dictionary be created as it is certain there will be more requests for such information for other research projects in the future. The health informatics problem tackled for this report is one that is related to the next step in the development of systemic therapy quality indicators. Because a framework specific to cancer systemic therapy was not found in the literature the author chose to create one based on the indicators and frameworks that were found. Both common and relevant framework dimensions were used and these were then populated with relevant indicators from the literature search. The dimensions used for the framework are: • Accessibility • Effectiveness • Appropriateness • Efficiency • Safety • Patient Satisfaction Some indicators were created “from scratch” to fill in some missing gaps in the framework. This framework may be useful to informing discussions regarding indicator selection for the current project. With the completion of the first phase of the systemic therapy surveillance project, it can now be seen what needs to occur next. The following recommendations are made at this time: • Assemble a working group to review the results of the literature review and select indicators that are relevant for local stakeholders. A list of indicator criteria and considerations was compiled and will be useful in these discussions. As well, consideration should be given to the creation of novel indicators where necessary. • Examine more closely the feasibility of altering the MEDITECH Pharmacy Module to capture regimen level drug information. If it is found to be feasible, then steps should be taken to implement the change. • Acquire the necessary details regarding the Pharmacy Module data variables that would be used in the data linkage and in the calculation of indicators. This would be done with systems analysts and Pharmacy Application Team members. • Perform a trial data linkage with a test sample of data from OPIS and MEDITECH. This will uncover any hidden obstacles and begin to show the merit of the linkage project. At this point, the project remains feasible. There are a few obstacles to be overcome, but with perseverance and a continuation of the current momentum, the final goals of enhancing the surveillance and reporting of systemic therapy in Nova Scotia will become a reality.