The Ninth Annual Navigation & Survivorship Conference has more than 900 nurse and patient navigators are anticipated to come to Dallas and discuss their role in the perpetually evolving oncology care landscape.
Diagnostics, workup, and treatment may be complete, but the journey across the cancer care continuum will continue through survivorship management. There are currently over 15 million cancer survivors, and that is to increase to 20.3 million (a 31% increase) by 2026 in the United States alone . In contrast, statistics from about 50 years ago was a count of 3 million survivors in 1971. This dramatic increase is primarily attributed to an aging population, earlier detection, and advanced treatment .
The concept of cancer survivorship is not new; it has been over 30 years since Dr. Fitzhugh Mullan described survivorship as a unique phase of cancer care and introduced the idea of “seasons of survivorship. ” Since then, this concept has evolved and continues to create some controversy with regards to its exact onset and duration . These can generally be categorized into three categories:
- Phase 1 – acute survival – time from diagnosis to completion of initial treatment
- Phase 2 – extended survival – time from completion of treatment to remission, with careful observations of outcomes from treatments
- Phase 3 – long-term survival
Our focus and attention will be on the period following final treatment and prior to the development of cancer recurrence – long-term survival. Historically, this stage has not been a focus of the care continuum and has several areas of concern, including a less frequent check-in with healthcare providers. Once primary treatment is completed, many patients are often lost to follow-up; are unaware of the heightened health-risks and are ill prepared to manage their medical and psychosocial concerns.
Part of the difficulty with this phase is that it is unique not only for each cancer, but also its various types. For instance, the 5-year survival for breast cancers diagnosed during 2010-2014 is 90.2% in the United States. Its hazard of reoccurrence is highest during the first 5 years at approximately 10%, with the estrogen receptor positive disease maintaining a significant recurrence rate beyond 5 years . For prostate cancers in the United States, the 5-year survival is nearly a 100% , with a wide recurrence of 30% – 90% . The high variety of survival rates along with the range of cancer reoccurrence informs the need for tailored surveillance programs.
Follow-up care concerns have become more pertinent in recent years as the new generation of cancer survivors are living longer due to improved access to effective screening, diagnosis, and treatment initiatives. Consequently, the health care delivery system is looking at solutions to efficiently and effectively navigate the long-term and late effects of cancer care as well as other chronic conditions, while taking into account the demands for patient-centered quality of care across the cancer care continuum.
The transition from active treatment to post-treatment care is a critical period for maintaining and enhancing long-term individual and population health. Evidence-based strategies need to be implemented across health systems to ensure that optimal health outcomes are met. Quality of care during survivorship is dependent on essential components of care, as well as ease of access to comprehensive and coordinated care.
Cancer survivorship encompasses:
- Prevention through screening of new and recurrent cancers
- Surveillance of cancer recurrence
- Monitoring of medical and psychosocial late-effects, incorporating interventions for intended and unintended consequences of cancer treatment
- Coordination of care between health professionals to ensure that all the health needs of survivors are met
In order to deliver optimal cancer survivorship care, fundamental changes are needed to ensure that all survivors receive care that is safe, timely, effective, efficient, patient-centred, and equitable. Leading health care systems foster and embrace the creation of an infrastructure to support evidence-based practices. In a world that is complex and continuously enhancing, leading health care systems utilize information technology to better assist health care professionals and patients with cancer care navigation.
Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development.
Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing
Cancer screening procedures strive for effective early detection. In order to screen large numbers of at risk individuals, screening practices need to be simple, cheap and efficient. Diagnostic tests are used to determine the presence or absence of cancer. Symptomatic individuals, or individuals with positive cancer screening results, go through potentially invasive and expensive diagnostic procedures to establish the presence of a tumor.
As the cancer journey is complex and convoluted, the patient needs to meet with health professionals with different skill sets to facilitate the process. An oncologist oversees a patient’s care from diagnosis and throughout the course of treatment. Patients consult with their general practitioner and, at times in combination with, health insurance providers to be referred to the most appropriate oncologist. Databases, such as the American Society of Clinical Oncology (ASCO) , also provide open access lists.
Within the United States, approximately one third of patients aged 0 – 64 years (a population of approximately over 90 million) are referred to a specialist by their primary care physician . A well-coordinated referral system needs to be established to accommodate this high frequency of referrals, in addition to connecting primary and specialty care.
All members of the oncology care team (oncologists, general practitioners, radiologists, nurse navigators, patient coordinators, registered dietitians, etc.) play an integral role in enhancing the quality of care received. The care provided encompasses diverse aspects of health services. In addition to appropriate care that is timely and appropriate, other elements of cancer care include psychosocial assessment, suitable and timely referral, and individualized treatment that considers each patient’s needs and preferences. A multidisciplinary team is needed to address these tasks, which may create complexities to care coordination in both hospital and community settings. Challenges include recognizing health professional roles and responsibilities, communication between the care team and with the patient, managing scarce resources, and transitioning patients through care.
Digital technologies have aimed to address these challenges . These include:
Electronic Health Records (EHRs)
Patient reported outcomes measures
They are utilized to enable collaborative care coordination systems. Patient experience and outcome is enhanced when implementation of optimal technologies are coupled with proper training and support for patients and the care team.
Recent evidence-based research has proven that improving quality of care through enhanced communication and a well-coordinated system is advantageous for the patient, the medical team, and healthcare system. Researchers have embarked on a series of studies aimed at identifying quality measures. Two examples of these cover:
1. The impact of EHRs and oncology EMR tools used by multidisciplinary teams in GP-oncologist communication and facilitation of cancer care. 
2. Use of IT-enabled measurements and patient reported outcomes by patients and the care team to enhance patient-centered care (allowing for a seamless incorporation of patient perspectives into cancer care practices). 
As a patient moves through from screening and diagnostics to workup, treatment plan, and the care planning stages – clear communication, education tools, and access improve patient engagement.
In our next article, we will take a closer look at different ways of engaging patients and their caregivers (e.g. patient portals, patient reported outcomes, and patient-centred education), and how they can ultimately improve the quality of health outcomes.
Main resources: https://www.ncbi.nlm.nih.gov/books/NBK223387/
Written by Dorri Mahdaviani , who holds a Masters of Public Health (MPH) from the University of British Columbia (UBC). Her academic and professional interests include the areas of chronic illnesses, health care systems and childhood health and development.
Infographics and Design by Ann Wong, who holds a PhD in Biochemistry and Molecular Biology from the Faculty of Medicine at the University of British Columbia (UBC), Canada. She is an author of over 10 SCI publications, having taught at UBC and the Peking University Health Science Center (PUHSC) in Beijing.
Vancouver, CANADA – August 23, 2017– Equicare Health Inc., the leading supplier of Oncology care coordination solutions, teams up with Lexington Medical Center to expand integration to include Enterprise Electronic Health Record (EHR) information. The new integration gives customers using an enterprise EHR the opportunity to integrate data from their EHR Medical Oncology Information System with Equicare’s Care Coordination system (ECS). For organizations running one Oncology Information System (OIS) or a variety of vendor systems in many locations, Equicare serves as a bridge to consolidate data, manage compliance, and engage patients. The system streamlines data flows and allows patients and care providers to securely access data 24 hours a day, regardless of treatment location.
“When we recently switched our Medical Oncology system, we worked with Equicare to add support for integration to our Epic enterprise EHR,” says Jo Anne Covar, Director of Integration and Development at Lexington Medical Center. “With this integration now in place, we can consolidate patient data in ECS from the OIS systems used in both our Medical and Radiation Oncology departments. Our partnership with Equicare has allowed us to meet our goals of providing a robust navigation and survivorship program that operates across Oncology, minimizes duplicate data entry, and embeds clinical best practices.”
“Two additional collaboration projects with Equicare are pending as well. One will be to develop a single-sign-on (SSO) solution between the Equicare Patient Portal – which is designed for oncology patients – and our EHR enterprise portal. The second project will be to design and implement some additional integration points between the two portals using the new Fast Healthcare Interoperability Resources (FHIR) standard,” adds Covar. “This will provide enhanced navigation and improved portal access capability in order to give our oncology patients a more seamless experience.”
The new feature contributes to the automated creation of oncology-specific survivorship care plans by extracting demographic, appointment, staging, chemotherapy, and hormone data from a customer’s EHR Medical Oncology Information System. When combined with existing functionality and data extracted from other OIS systems, the need for extra HL7 interfaces is dramatically reduced. The Equicare integration with this EHR provider will give customers more options for managing Oncology care coordination.
“We’ve been providing rich integration with other OIS systems for some time. By adding support for an EHR Medical Oncology Information System, we provide more options for customers requesting to use Equicare’s navigation and survivorship tools across their Oncology practice,” says Margaret Nash, VP of Global Sales at Equicare Health. “We are pleased to be in a position to close this gap for them and can’t thank the team at Lexington Medical Center enough for their leadership in this area.”
About Equicare Health
Equicare Health is the industry’s leading provider of comprehensive care coordination solutions. Equicare’s flagship solution EQUICARE CS™ (ECS) is a Multi-facility web-based software tool that facilitates patient engagement including patient reported outcomes, patient navigation, survivorship care and a number of other clinical tools, i.e. MDT, Clinical trials, a suite of educational material, etc.. In additional to the clinical toolset, Equicare also offers an administrative suite of worklists and reports for managing adherence to accreditation standards including Meaningful Use, Commission on Cancer (CoC), NAPBC, QOPI, OCM, etc… ECS enables cancer centers to influence clinical outcomes for patients, optimize revenue streams, and increase operational efficiency. www.equicarehealth.com
About Lexington Medical Center
Lexington Medical Center is a 428-bed hospital in West Columbia, South Carolina. It anchors a health care network that includes six community medical centers and employs a staff of more than 6,500 health care professionals. The network also has cardiovascular and oncology care affiliated with Duke Health, an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer’s care center and 60 physician practices. Lexington Medical Center operates one of the busiest Emergency departments in South Carolina, treating nearly 85,000 patients each year. The hospital delivers more than 3,500 babies each year and performs more than 23,000 surgeries. Lexington Medical Center is currently undergoing the largest hospital expansion in South Carolina history by creating a new patient tower that will open in 2019. Lexington Medical Center has a reputation for the highest quality care. www.lexmed.com
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With the release of ASTRO’s new survivorship care plan template in late November, we’ve seen a renewed focus on the care plan, and the logistical problems of delivering one. What should a care plan look like and how do you choose a template?
The evidence for the need for care plans is strong. As ASTRO states in their press release, the American Cancer Society (ACS) predicts a 37% increase in the number of cancer patients surviving five years or longer over the next decade, and as the numbers of survivors grows, so does the need for structured follow up care. Accrediting bodies like the ACS Commissions on Cancer (CoC) have included survivorship in their new requirements but providers report that delivering a survivorship care plan is the most difficult of the CoC’s new standards to meet (Association of Community Cancer Centers, 2015 membership survey).
The need for clarity on care plan content and format has resulted in a variety of care plan templates. The ASTRO care plan, designed for Radiation Oncologists, joins templates from organizations including ASCO, LiveStrong, Journey Forward and others. Each template varies slightly, but most include the following common elements:
- Contact information for the patient’s care team
- Patient diagnosis
- Treatment summary including radiation therapy, chemotherapy, surgery, and enrollment in clinical trials.
- Information on the side and late effects of treatment
- Psychosocial distress screening
- Follow-up plan
Most of these templates, including ASTRO’s latest addition, pack all that information into a short 2 -3 page format. We know that many providers value the concise nature of these templates and others want to include much more.
So how much information should we include in a care plan? How many years do we look ahead for follow-up? How many years of treatment history are necessary? Do we include educational articles and community resources within the care plan?
With a variety of templates from industry leaders, the answers to these questions aren’t clear. Will a long care plan overwhelm some patients? Or does a shorter plan run the risk of missing valuable information? Depending on the patient, both may be true.
The right level of detail depends on the age, education level, diagnosis and treatment of the specific patient. A one-size-fits-all care plan probably doesn’t exist but if we focus on where we can add the most value for patients, we’ll probably find the right balance.
As a vendor of survivorship software, we’re hardly neutral on this subject, but we are certainly passionate about doing the right thing for patients. Equicare’s care plans can be as sparse as this 2-pager with just a treatment summary and follow up plan. Or as detailed as this comprehensive one, which also includes detailed educational articles and info about questionnaires to complete. Our goal is to deliver a care plan that not only ticks the requirements box of your accrediting body (which we certainly do!) but to make it easy for you to deliver a care plan that adds value to your patients, their families and your physicians.
|2 Page Care Plan|
|Comprehensive Care Plan|
Which template do you use? And why do you love or hate it? We’d love to talk templates, so get in touch and let us know.
Thanks to everyone who made HIMSS15 in Chicago a successful event this year! Our first year exhibiting at HIMSS, we joined more than 1,300 exhibitors and 40,000+ attendees for this world-class event focused on major global issues in healthcare—including care coordination, population health management, and optimizing cost efficiencies.
Prominent keynote speakers, including Former President George W. Bush and current National Care Coordinator Dr. Karen DeSalvo, addressed the necessity of patient-focused and cost-effective care, as well as the large-scale impact of developing comprehensive population health management systems.
Steve Lieber, President & CEO of HIMSS, echoed these ideas, noting that organizations must embrace technology as a vital tool for connecting people to the healthcare system and affecting critical change to improve care.
At Equicare, we support these goals in everything we do. EQUICARE CS, our comprehensive care coordination solution, helps organizations improve patient outcomes with better quality care, while increasing operational efficiency and reducing costs. Everyone wins!
It’s been a busy spring at Equicare Health! After attending two workshops at the end of February—Commission on Cancer’s (CoC) Accreditation 101 in Chicago and the UPMC: Cancer Survivorship for Healthcare Providers in Pittsburgh—, the Equicare team had the pleasure of participating in two industry events in March.
We headed to Arlington, VA for ACCC’s 41st Annual Meeting: CANCERSCAPE, where attendees gained insights into the healthcare policy landscape, quality measures and reporting, and the potential for big data to improve care. We were delighted to demonstrate how EQUICARE CS can help cancer centers improve patient care through coordinated navigation, survivorship, distress management and patient engagement programs.
NCBC was a wonderful opportunity to visit with our current customers and make new connections with other medical and industry professionals who are as dedicated as we are to improving breast health care for patients throughout their cancer journey—from diagnosis to treatment and through survivorship.
The HIMSS Annual Conference & Exhibition starts tomorrow in Chicago, showcasing the newest technologies, trends, and solutions in health IT. Equicare will be there—with 38,000 of our closest friends— to demonstrate how we can help cancer centers and hospitals improve patient care and increase revenues. Drop by Booth 3376 to learn how EQUICARE CS can streamline your patient care coordination and help you deliver unparalleled survivorship care. Hope to see you this week!
Chicago welcomes the 2015 HIMSS Annual Conference & Exhibition, April 12-16, 2015, at McCormick Place. More than 38,000 healthcare industry professionals are expected to attend to discuss health IT issues and view innovative solutions designed to transform healthcare. We’re looking forward to showcasing EQUICARE CS, our complete oncology patient management solution, at this annual event.
Conference education sessions include pre-conference symposia on clinical and business analytics, HIEs, innovation, mobile health, nursing informatics, physicians’ IT and more. More than 300 peer-reviewed sessions, including workshops and roundtables, round out education offerings at HIMSS15.
George W. Bush, 43rd President of the United States, leads a strong roster of speakers that also includes Alex Gourlay, President, Walgreens; Bruce D. Broussard, President and CEO, Humana; and Jeremy Gutsche, Founder of Trendhunter.com and Author of “Exploiting Chaos.”
The HIMSS15 Exhibit Hall will feature the Connected Patient Gallery, Federal Health IT Solutions Pavilion, HIMSS First-Time Exhibitors Area, HIMSS Health IT Value Suite, HIMSS Interoperability Showcase™, Intelligent Health™ Pavilion (formerly known as Intelligent Hospital Pavilion), and three Knowledge Centers focused on clinical and business intelligence, disaster preparedness, and mobile health.
Drop by Booth #3376 for a demo of EQUICARE CS, our innovative patient care coordination solution. We look forward to seeing you!
Is it really possible to create a survivorship care plan that includes all of the Institute of Medicine’s recommendations in less than 5 minutes? The answer from Equicare is an emphatic YES. With the right tools you can prepare a comprehensive care plan that includes a treatment summary, targeted educational materials, scheduled questionnaires, a long term follow-up plan, care team contact info and more.
How do we compile all that data so quickly? The key is in the interfaces we create between EQUICARE CS and your hospital information systems. By pulling existing patient data into the system, you eliminate manual data entry to very quickly prepare a patient specific care plan, which can be printed for patients and PCPs, and online through a patient portal.
Demo: Create a survivorship care plan in less than 5 minutes
If you want to see exactly how it works, just play the video below, where we walk through all the steps in care plan creation in just over 3 minutes
Based on our experience, most oncology healthcare providers believe in the value of navigation and survivorship, and most patients appreciate having access to it. These services can help providers ensure patients receive the long-term care they need, and help patients play a more active role in their health. The Institute of Medicine has been advocating survivorship since their 2005 “Lost in Transition” paper, and the American College of Surgeons Commission on Cancer has now changed their accreditation requirements to include survivorship planning.
So why isn’t everyone doing it? One of the most common obstacles organizations face is cost. Managing a large-scale survivorship program usually requires the use of new electronic tools, and often hiring dedicated staff members. For many organizations, the investment is hard to justify, especially in a time of shrinking budgets.
What many organizations don’t realize is that survivorship & navigation can actually deliver a return on investment, often within a few years of implementation. We are now pleased to introduce a Pro-forma tool that calculates what we expect this return to be. For example, take a look at the 5-year return from 2 fictitious, though typical, organizations below.
This tool was developed in partnership with American Medical Accounting & Consulting Inc (AMAC), one of the leading firms in the radiation oncology industry. Based on this reimbursement data, and information about the size, make-up and growth projections of an organization, we can calculate an expected 5-year ROI to help justify an initial investment. Although the data above is fictitious, it represents the real return organizations can expect to realize when using an electronic survivorship product like EQUICARE CS.
Don’t believe us? Let us prove it! Contact us to learn more about where these numbers come from and get an ROI calculation specific to your organization.
More questions? We’ll try to answer some below:
- What’s the difference between incremental net income and ROI?
The ROI is simply the difference between the total revenue and expenses of managing a survivorship program. The incremental net income is the difference between the ROI an organization realizes when using an electronic tool like ECS, and the ROI from running a manual survivorship program. This is an important figure to present when considering whether to introduce an electronic tool, or attempt a manual program.
- What is a manual survivorship program?
In the table above, we reference a manual survivorship program – this is how we describe programs that are run using paper or excel spreadsheets. While it’s possible to run a program like this, it’s less efficient, and for some organizations, particularly free-standing clinics like the one in the example above, actually causes the organization to lose money.
- Where does the revenue come from?The major sources of revenue are from:
- Increased rates of patient attendance at reimbursable follow-up appointments
- Increased Nurse Navigator efficiency – fewer FTEs can manage the same (or more) patients
- For hospitals with imaging – we include revenue from additional in imaging studies, which may have been lost without survivorship & navigation
- Do you include staff salaries in this calculation?
Yes, we use your current size and plans for the growth of the program to estimate the number of nurse navigators (or other dedicated employees) required to manage the program now and in the years to come. This is included in the expense calculation.