EMR-linked cancer tracker facilitates lung and liver cancer care.

Abstract

77 Background: VA Connecticut Healthcare System has developed a web-based, EMR-linked Cancer Care Tracking System (CCTS) to facilitate tracking and follow-up of patients with imaging abnormalities concerning for lung or liver cancer. The tracker was developed to facilitate the efforts of a multidisciplinary team at the center of which is a cancer navigator. Methods: CCTS was first envisioned in 2007 when VACT hired a care navigator and implemented a radiology coding system to identify potential cancers. This created the need for a tool to process abnormal images and track the clinical steps required to reach a definitive diagnosis and treatment plan. CCTS was initially used for lung cancers and was expanded to track hepatocellular carcinoma (HCC) in 2009 with additional funding. In addition to case discovery, it offers easy access to patient information with live links to the VA EMR, a surveillance feature, and scheduling, alerting, and reporting functions. In 2011, the system was enhanced with a natural language processing (NLP) program that automatically identifies radiology reports describing potentially malignant lung or liver lesions. Results: CCTS has been in daily operation since February 2010, with 1,778 patients and 2,503 patients tracked in 2010 and 2011, respectively. Addition of NLP technology significantly increases the accuracy of identification of patients with lung or liver nodules. The NLP system identified 21% of all new cases with potential malignancies whose management could have been delayed through coding omissions or errors. Benefits of CCTS and our cancer care coordination program have included a decrease of 25 days in the time from abnormal image to treatment of lung cancer, a significant increase in the diagnosis of stage I/II lung cancers from 32% to 48%, and an increase in the incidence of liver cancer from 1% to 5% of all cancers at VACT. Conclusions: A web-based, EMR-linked cancer care tracking system (CCTS) improves cancer detection, prevents loss to follow-up, provides a safety net for radiology coding omissions or errors, and improves provider efficiency. CCTS is an innovative tool to support multidisciplinary cancer care and has broad applicability to any electronic medical record.