Chemotherapy Management Candidate Services

1. Chemotherapy Management Candidate Services caCIS Chemotherapy Mgmt and Treatment Planning CFT Meeting Rob Hausam ClaranceHowatt revised 1/24/2011 /trunk/documents/architecture/Chemotherapy Management Services/Chemotherapy Management Candidate Services.pptx

2. Rationale for Modeling Approach • Chemotherapy is a treatment • Chemotherapy management is about treatment planning • Chemotherapy management (ordering, administration, monitoring, etc.) is complex, but is a choreography built from common components • Order management, substance administration, scheduling, etc.

3. Caveats • Not yet vetted with Analysts • DAM contains further details • Considerable work has been done in modeling for treatment planning (Jean Duteau)

4. Clinical Scenario • /trunk/documents/architecture/Chemotherapy Management Services/Clinical Scenario for Chemotherapy Management Services.doc • Based on SJO Patient Scenario • /trunk/documents/analysis/Resources_Research/St_Joseph_Orange/SJO Patient_Scenario_final.doc • Context • 47 y/o woman with breast cancer • metastatic invasive ductal carcinoma, with ER+, PR+, HER2/neu- receptors • Positive family history • Stage T2N1M0 • Referred for consultation for neo-adjuvant chemotherapy prior to surgical intervention

5. Sub-Scenarios / Component Diagrams • Author Treatment Plan • Update/Revise Treatment Plan • Implement Treatment Plan

6. Author Treatment PlanComponent Diagram

8. Top Level Component • “Chemo Management Choreography” • “Executes” steps of the Treatment Plan • What is it? • UI in Reference Implementation? • High-level orchestrated task service? • Something else?

9. Author Treatment Plan • Review patient medical record and referral documentation • Select appropriate treatment plan template for breast cancer • Bind template to the patient to create the initial treatment plan • Individualize the treatment plan to create a proposed patient-specific treatment plan

11. Author Treatment Plan Candidate Services • Treatment Plan Template Management (Template Management) • Treatment Plan Management (Treatment Plan) • Patient Registry • Clinical Services (group) • Document Exchange • Lab Result • Image Management

12. Treatment Plan Template Management Service • The Treatment Plan Template Management Service is a standards-compliant service that can be used to create and manage templates for treatment plans in clinical care and/or clinical trial settings. Treatment plan templates provide a standard representation of recommended sets of clinical care or trial activities, which can be accessed by the Treatment Plan Management Service for association with a specific patient and individualization as a treatment plan to be used for scheduling and managing the clinical care or trial activities for that patient. These activities may commonly include but are not limited to chemotherapy and other medication ordering and administration, radiotherapy ordering and administration, laboratory and radiologic testing, surgical and radiologic interventions, etc. Treatment plan templates may be obtained in various forms from multiple sources, including national and other formal clinical and research standards setting organizations as well as local patient care and research institutions.

13. Treatment Plan Template Management Service • /trunk/specifications/CFSS_Treatment_Plan_Template_Management_Service.doc

14. Treatment Plan Management Service • Treatment plans are common to clinical care and clinical trials settings. The process of carrying out a treatment plan in both cases follows similar steps: initial assessment, planning, implementation of the plan, and assessment of the plan and outcomes. The Treatment Plan Management Service is a standards-compliant service that can be used to manage these plans in clinical care and/or clinical trial settings. The Treatment Plan Management Service addresses the commonalities of individualized treatment plans, based on the association of clinical care or trial protocol templates with a specific patient and modification of the plan details as required to meet the particular patient’s needs and manage the scheduled clinical care or trial activities. These activities may commonly include but are not limited to chemotherapy and other medication ordering and administration, radiotherapy ordering and administration, laboratory and radiologic testing, surgical and radiologic interventions, etc. The implementation of these individualized treatment plans facilitates the forecasting of visit information for future treatment plan activities and provides a framework for historical treatment plan activity review and outcomes assessment.

15. Treatment Plan Management Service • /trunk/specifications/CFSS_Treatment_Plan_Management_Service.doc

16. Author Treatment PlanComponent Diagram Walk-through

18. Update/Revise Treatment Plan • Discuss proposed treatment plan with patient • Obtain additional pertinent information from patient • Modify proposed treatment plan, if required • Obtain patient consent • Document finalized initial treatment plan • Schedule initial round of chemotherapy • Patient, provider, facility, (pharmacy?) • Order baseline lab tests and imaging • Order additional items and procedures • Port-a-cath placement • Pre-chemo medication

19. Update/Revise Treatment PlanComponent Diagram

21. Update/Revise Treatment Plan Candidate Services • Treatment Plan Management (Treatment Plan) • Consent Manager • Patient Registry • Scheduling (Scheduling Centre) • Referral (Referral Consult) • Order Request Management • Medication Ordering • Image Management (Diagnostic Imaging Centre) • Lab Order • Pharmacy

22. Medication Ordering Service • The Medication Ordering Service is a standards-compliant service for managing medication orders • Implements an Order Request Management pattern or works in conjunction with an Order Request Management Service • No CFSS available yet

23. Update/Revise Treatment PlanComponent Diagram Walk-through

25. Implement Treatment Plan(iterative) • Administer chemotherapy • Order lab and other diagnostic tests (monitoring) • Prescribe additional medications • E.g. anti-emetic, Procrit • Revise treatment plan as needed • Schedule future chemotherapy cycles

26. Implement Treatment PlanComponent Diagram

28. Implement Treatment Plan Candidate Services • Treatment Plan Management (Treatment Plan) • Medication Administration • Consent Manager • Patient Registry • Scheduling (Scheduling Centre) • Order Request Management • Image Management (Diagnostic Imaging Centre) • Lab Order (Clinical Services) • Pharmacy

29. Medication Administration Service • The Medication Administration Service is a standards-compliant service for managing the details of medication substance administration events and their associated data • E.g. date/time, performer, adverse events and exceptions, etc. • Electronic MAR • No CFSS available yet

30. Implement Treatment PlanComponent Diagram Walk-through

32. Next Steps • Review and comments • Validate models with Analysts • Figure out scheduling / ordering relationship • Determine specific nature of “top-level” component (“Chemo Management Choreography”) • Others?

33. Questions?