Sometimes, missed and delayed cancer diagnoses can result from breakdowns in communication and the ability to coordinate abnormal findings that may indicate cancer. This situation often first emerges in the primary care setting.
The study “Automated Point-of-Care Surveillance of Outpatient Delays in Cancer Diagnosis”(CRE 12-033-HSR&D Study) is ongoing at the Michael E. DeBakey VA Medical Center in Houston (VISN 12) www.houston.va.gov with Hardeep Singh MD, Principal Investigator studying how to provide new and faster ways to detect cancer using available data.
The VA has noted that delays have resulted in the follow-up of abnormal test results despite the reliable delivery of test results through EHRs. Methods to detect these delays and identify “high risk” patients are underdeveloped and need to be optimized for use within Patient Aligned Care Teams (PACT).
So far, the VA has conducted a pilot to determine whether the use of electronic queries or “triggers” can proactively identify patients at risk of delayed cancer diagnosis. The VA has reviewed selected medical records that show some evidence of possible care delays such as charts with no documented follow-up of abnormal chest X-ray after 30 days. More than half of the charts identified by the triggers were confirmed on chart review not to have follow-up and the communication rate to providers was slow and inefficient.
The first step for researchers is to develop and test an innovative automated surveillance intervention to improve timely diagnosis and follow-up on five common cancers in primary care practice. The researchers will use the VA Informatics and Computing Infrastructure (VINCI) to find information on possible delays.
Next, the goal is to find out how to integrate real-time surveillance and communicate information concerning at risk patients to the PACT team care using informatics and human factor engineering principles.
At that point, researchers will develop and test algorithms to trigger records lacking documented follow-up action after pre-defined diagnostic clues for cancer. They will also perform interviews, task analysis, and use participatory design techniques along with usability testing to ensure that the automated intervention will be within the workflow of the real-world clinical practice.
The researchers will then extract data daily within the VINCI platform to identify patients at risk of diagnostic delays and automatically communicate this information to PACT teams that their patients that are experiencing potential delays.
So far, the development of the lung cancer trigger has been completed along with efforts by researchers to communicate to other facilities within VISN 12 on the actions and results of the pilot. Also, researchers are working hard to recruit many facilities in VISN 12 to participate in the project. Inroads have be made and logistics have been set up so that needs assessments can now be conducted.
Go to www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141701900 for more details on CRE 12-033-HSR&D Study.