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Jerome Foster

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  • OS10 - Disease and Clinical Management with Technology (ID 16)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 6/06/2017, 10:30 AM - 12:00 PM, Room 205B
    • OS10.03 - Technology Streamlines Screening Techniques and Saves Lives (ID 277)

      Jerome Foster, New Brunswick Department of Health; Fredericton/CA

      • Abstract
      • Slides

      Purpose/Objectives: The New Brunswick Department of Health has implemented an innovative, centralized Cancer Screening System that saves lives and reduces the cost of treating cancer. Colon cancer is New Bruswick's third most common cancer and the second deadliest cancer. Using existing information held within Department of Health databases, probabilistic algorithms identify and enable the selection of candidates for Colon cancer screening by evaluating information held in Medicare, the Client Registry, and the Cancer Registry. Where other provinces use mostly manual processes, the availability of these data sources to New Brunswick Cancer Network has enabled this system to operate with increased automation.

      Methodology/Approach: The Cancer Screening program leverages investments made in the New Brunswick Electronic Health Record and data registries to support decision making while reducing effort and cost duplication. The current screening program would not be possible without the foundation of the One Patient One Record infrastructure. The provincial Client Registry is used to determine who to invite to the screening. Patients who agree to participate send their requisition sample into a provincial lab to have the test performed, and the Laboratory results are transferred via the Rhapsody Integration Engine to the Orion Clinical Data Repository. The Rhapsody messages are also transferred to another Cancer screening data repository that supports the screening processes. The EHR, Orion Clinical Portal, displays the results and nurses review with patients as they complete the pre-Colonoscopy assessment over the phone. Since results are electronic, the nurses who currently work in Fredericton can work from anywhere in the province. After the colonoscopy, the pathology report is reviewed by the nurses via the EHR. It's important to note that other health care providers have access to these results as well, through the EHR, for continuity and ongoing care of the patient. The notification of the physicians or nurse practitioners is an important factor to ensure that the patients receive appropriate follow up. Relevant information is routed to the patients’ care team NextGate Provider Index. Provider Index, the EHR viewer and Rhapsody messages enable the flow of information and build the foundation for the screening’s highly-automated, algorithm-based cancer screening.

      Finding/Results: As of July 31, 2016 there has been a 30% participation rate of solicited persons in the screening. To date, we have found 37 cancers in asymptomatic individuals. Additionally, 390 persons had polyps removed preventing cancer development. These screenings identified patients before cancer could progress, avoiding significant health risks to patients, and realizing cost savings to the province.

      Conclusion/Implication/Recommendations: Before the integrated Cancer Screening's implementation there was no centralized, systematic way to identify and invite participants to be screened. By leveraging investments in existing provincial information technology systems and integrating data to build an automated algorithm to identify at-risk patients, New Brunswick has prevented cancer in many patients. The “business process automation” in the integrated Cancer Screening now enables proactive invitation of eligible NB citizens to engage in early detection of cancers. This technology allows for efficient delivery of the screening and ensures all providers are able to access test information.

      140 Character Summary: The NB Department of Health has implemented an innovative system to support Cancer Screening that is saving lives and reducing the cost of treating cancer in NB

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