Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 1 Presented By: Alice Chow Ray Yip Michelle Burke Anne-Marie Lesko Presented On: March 8, 2015 MMI 404 Winter 2015 Homosassa Cancer Center Florida Health Alliance Hospital “Personalized” Cancer Therapy 1
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Homosassa Cancer Center “ using knowledge to reduce the burden of human cancer” Slide 1 Presented By: Alice Chow Ray Yip Michelle Burke Anne-Marie Lesko.
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Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 1
Presented By: Alice ChowRay Yip
Michelle BurkeAnne-Marie Lesko
Presented On: March 8, 2015MMI 404 Winter 2015
Homosassa Cancer CenterFlorida Health Alliance Hospital
“Personalized” Cancer Therapy
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Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 2
Precision Medicine (PM)...
...is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 3
PharmacoGenomics (PGX)...
...uses information about a person's genetic makeup, or genome, to choose the drugs and drug doses that are likely to work best for that particular person.
It combines the science of how drugs work, pharmacology, with the science of the human genome, genomics.
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 4
Precision Medicine Initiative: Objectives
• More and better treatments for cancer• Creation of a voluntary national research cohort• Commitment to protecting privacy• Regulatory modernization• Public-private partnerships
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 19
Integration of Genomic Data With Electronic Health Records. From Crossing the Omic Chasm A Time for Omic Ancillary Systems by Starren, J., Williams, M. S., & Bottinger, E. P. (2013, Mar 27). Retrieved from JAMA: http://jama.jamanetwork.com/article.aspx?articleid=1666972
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 20
source: GenomOncology (2014)
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 21
source: GenomOncology (2014)
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 22
Building Genomic CDS in EHR
Images from Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: A mixed methods approach by Devinea, et al. (2014). Retrieved Feb 23, 2015 from http://www.sciencedirect.com/science/article/pii/S1386505614000689
Example: Evidence based knowledge about PGx results Example: PGx-CDS Alert
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 23
Proposed Architecture
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Proposed Scope
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High level Roadmap
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Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 26
Success Metrics & Goals High Standards of Quality● measured by ASCO QOPI calculations● 80% score to achieve ASCO quality certification
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 34
Potential Revenue Increase for Breast Cancer
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* Harvard Business Review article by Rita Gunther McGrathand Ian C. MacMillan in 1995
Return on Innovation Measures Growth
Expansion of CDSS functionality
Renewed commitment to patient centric approaches
Genetic testing incorporated into clinical pathways
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Summary
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APPENDIX
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Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 38
REFERENCESCarlson, J. J., Garrison, L. P., RAY Ramsey, S. D., & Veenstra, D. L. (2009). The potential clinical and economic outcomes of
pharmacogenomic approaches to EGFR-tyrosine kinase inhibitor therapy in non-small-cell lung cancer. Value Health, 12(1), 20-27. doi: 10.1111/j.1524-4733.2008.00415.x
Cimino, G. D., Pan, C.-x., & Henderson, P. T. (2013). Personalized medicine for targeted and platinum-based chemotherapy of lung and bladder cancer. Bioanalysis, 5(3), 369-391. doi: 10.4155/bio.12.325
Crawford, J. M. M. P. (2014). The Business of Genomic Testing: A Survey of Early Adopters. Slide Share: Knome_Inc.
Devinea, E. B., Leea, C.-J., Overby, C., Abernethy, N., McCune, J., Smith, J. W., & Tarczy-Hornoch, P. (2014, Apr 15). Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: A mixed methods approach. Retrieved from International Journal of Medical Informatics: http://www.sciencedirect.com/science/article/pii/S1386505614000689
Fenstermacher, D. A., Wenham, R. M., Rollison, D. E., & Dalton, W. S. (2011). Implementing Personalized Medicine in a Cancer Center. Cancer journal (Sudbury, Mass.), 17(6), 528-536. doi: 10.1097/PPO.0b013e318238216e
Guttmacher, A. E., McGuire, A. L., Ponder, B., & Stefansson, K. (2010). Personalized genomic information: preparing for the future of genetic medicine. Nat Rev Genet, 11(2), 161-165.
Huttin, C. C., & Liebman, M. N. (2013). The economics of biobanking and pharmacogenetics databasing. Technology & Health Care, 21(2), 183-190.
Joseph L. Kannry, M. S. (2013). Integration of genomics into the electronic health record: mapping terra incognita. Retrieved from Genetics in Medicine: http://www.nature.com/gim/journal/v15/n10/full/gim2013102a.html
Kreys, E. D., & Koeller, J. M. (2013). Documenting the benefits and cost savings of a large multistate cancer pathway program from a payer's perspective. J Oncol Pract, 9(5), e241-247. doi: 10.1200/jop.2012.000871
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 39
Malin, B., Benitez, K., & Masys, D. (2011). Never too old for anonymity: a statistical standard for demographic data sharing via the HIPAA Privacy Rule. J Am Med Inform Assoc, 18(1), 3-10. doi: 10.1136/jamia.2010.004622
Masys, Daniel R. et al. (2012). Technical desiderata for the integration of genomic data into Electronic Health Records. Journal of Biomedical Informatics , Volume 45 , Issue 3 , 419 - 422. Retrieved from http://www.j-biomed-inform.com/article/S1532-0464%2811%2900219-X/fulltext
Mehr, S. R. (2014, Feb 11). Is Medicare Ready for Oncology Clinical Pathways? Retrieved from The American Journal of Managed Care: http://www.ajmc.com/publications/evidence-based-oncology/2014/february-2014/Is-Medicare-Ready-for-Oncology-Clinical-Pathways
My Cancer Genome. (n.d.) Types of Molecular Tumor Testing. Retrieved from http://www.mycancergenome.org/content/molecular-medicine/types-of-molecular-tumor-testing/
National Cancer Institute. (n.d.) BRCA1 and BRCA2: Cancer Risk and Genetic Testing. Retrieved from http://www.cancer.gov/cancertopics/genetics/brca-fact-sheet
National Cancer Institute. (n.d.) Enhancing Breast and Ovarian Cancer Care: The Discovery of BRCA1 and BRCA2. Retrieved from http://www.cancer.gov/aboutnci/servingpeople/cancer-research-progress/discovery/brca
Quackenbush, J. P. (2012). Building a Program in Personalid Medicine. Slide Share: Dana-Farber Cancer Institute.
Scott, G., Shah, P., Wyatt, J., Makubate, B., & Cross, F. (2011). Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors. J. Am. Med. Inform. Assoc., 789–798.
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 40
SG2 Healthcare Intelligence Market Research Firm. (2013). Cancer : Service Line Snapshot.
Snow, S. (May 5, 2003). Cancer facilities find Lakeland to be inviting. Tampa Bay Biz Journal. Retrieved from http://www.bizjournals.com/tampabay/stories/2003/05/05/story2.html
Snyder, C. F., Wu, A. W., Miller, R. S., Jensen, R. E., Bantug, E. T., & Wolff, A. C. (2011). THE ROLE OF INFORMATICS IN PROMOTING PATIENT-CENTERED CARE. Cancer journal (Sudbury, Mass.), 17(4), 211-218. doi: 10.1097/PPO.0b013e318225ff89
Snyder, S. R., Mitropoulou, C., Patrinos, G. P., & Williams, M. S. (2014). Economic Evaluation of Pharmacogenomics: A Value-Based Approach to Pragmatic Decision Making in the Face of Complexity. Public Health Genomics, 17(5-6), 256-264.
Song, P. H., Reiter, K. L., Weiner, B. J., Minasian, L., & McAlearney, A. S. (2013). The Business Case for Provider Participation in Clinical Trials Research: An Application to the National Cancer Institute's Community Clinical Oncology Program. Health Care Manage Rev, 38(4), 284-294. doi: 10.1097/HMR.0b013e31827292fc
Starren, J., Williams, M. S., & Bottinger, E. P. (2013, Mar 27). Crossing the Omic ChasmA Time for Omic Ancillary Systems. Retrieved from JAMA: http://jama.jamanetwork.com/article.aspx?articleid=1666972
Suther, S., & Kiros, G. E. (2009). Barriers to the use of genetic testing: a study of racial and ethnic disparities. Genet Med, 11(9), 655-662. doi: 10.1097/GIM.0b013e3181ab22aa
The eMERGE Network. (n.d.). The eMERGE Network. Retrieved from The eMERGE Network: http://emerge.mc.vanderbilt.edu/
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 41
Current Facility Profile
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Organization Name Homosassa Cancer Center; owned and operated by Central Florida Community Health
Clinical Services Provided:
Outpatient chemotherapy and related therapies, Cancer screening, Radiation Oncology therapy, Psychological support, Oncology surgical services
MIssion Statement Reduce the burden of human cancer through the pursuit of knowledge and apply this knowledge to the prevention of cancer and the treatment of cancer patients
Hours of Operation: Monday thru Friday, 7 am to 9 pm
Number of Providers: 1 Chief of Oncology, 6 Employed medical oncologists, 10 Affiliated medical oncologists, 2 surgical oncologists, 1 radiation oncologist
Number of Mid-level Providers:
9--one for each employed physician and three to support the infusion center
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Facility Profile (cont)
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Other FTEs: 1 director, 1 nurse manager, 2 administrative assistants, 4 front desk staff, 25 RNs, 4 CNAs (certified nursing assistants), 2 pharmacists, 5 radiation technologists, 1 CDS specialist, 3 HIT Integration Specialists, 1 informaticist. For additional psycho-social support, there are also 2 social workers to help coordinate follow-up care and adherence..
Volunteer Pool: Members of the community who desire to support patients receiving oncology treatment may volunteer time in the infusion center as coordinated by an administrative assistant.
Patient Population & Characteristics:
Our 2014 Community needs assessment identifies that cancer is the leading cause of death in our region, with females between the ages of 60 and 79 suffering the highest instances of new cancer detection.
Homosassa Cancer Center “using knowledge to reduce the burden of human cancer” Slide 43
Facility Profile (cont)
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Facility Characteristics
● The first floor has a reception area, a 25-chair infusion center with a supply room and nurse’s desk areas, a staff room, a kitchen, and 6 offices (director, nurse manager, genetic counselor, social worker, etc).● The second floor has 10 physician offices, 10 exam rooms, 1 large conference room, 2 small conference rooms, 3 bathrooms, and a kitchenette. ● The third floor houses Radiation Services.● The fourth floor has 1 large conference room, 2 small conference rooms, 5 offices for IT staff, and 3 bathrooms. This floor is available for use for group classes, staff training as well as community educational opportunities.● Behind the structure is a Serenity Garden where patients and families may visit. A portion of the infusion chairs overlook the Serenity Garden.● The facility is equipped with internet and WiFi.
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