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caBIG ® Clinical Information Suite West Michigan Cancer Center Domain Expert Meeting Oct 27-28, 2010. Announcements, Introductions, & Updates. Wednesday, October 27, 2010. Announcements, Introductions, and Updates. Topic Agenda Wednesday October 27 . Topic Agenda Thursday October 28 .

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cabig clinical information suite west michigan cancer center domain expert meeting oct 27 28 2010

caBIG® Clinical Information SuiteWest Michigan Cancer CenterDomain Expert Meeting Oct 27-28, 2010

announcements introductions updates
Announcements, Introductions, & Updates

Wednesday, October 27, 2010

Announcements, Introductions, and Updates

dam changes review
DAM Changes Review
  • Outcomes Models
  • Encounter
  • Changes to Treatment Plan
  • Concerns
    • Allergies
    • Cancer
modeling chemotherapy activities
Modeling Chemotherapy Activities
  • There are three activities normally associated with an administration activity:
    • The Order
    • The Supply
    • The actual Administration
  • “Normal” prescriptions make the order and supply explicit but the administration is implicit and assumed.
    • We assume because you picked up your Crestor that you are actually taking it as told
  • Immunizations have an explicit administration with an implicit supply, but not very often an order
    • We have international use cases for an immunization order
  • Chemotherapy?
    • My first guess: an Order and an Administration with an implicit supply
cancer staging discussion
Cancer Staging Discussion
  • AJCC 7th Edition

1. ‘Staging Group’ = ‘Anatomic Stage/Prognostic Groups’

      • Anatomic Stage (Stage IIIB)
      • Prognostic Factors (HER2 status . . .)

2. Subtle but important changes on rules!

3. EHR cancer staging vs. Cancer Registry

      • Summary Staging?

4. Generalization back to Breast Cancer model

slide17

AJCC 7th

    • Some changes in TNM
    • Changes in terminology (6th Staging Group, in 7th is Anatomic Stage/Prognostic Group)
slide19

Anything missing?

    • Method used for staging (clinical vs. pathologic)
      • Histologic is pathologic, not clinical
      • Imaging stuff is clinical, not pathologic
      • Not consistent which has more information
      • Both will be recorded
    • Laterality – where would it come from? (ICD-9-CM); quadrant on breast seems to be important for billing, as well as proximity to nipple; does not actually affect actual stage
    • With neo-adj, may get pathology after chemo
      • ypT, ypM, ypN
slide20

Need a “field” for “Mitotic rate”

  • Duke (for colorectal)? Don’t support using?
  • Siewert? Sounds like it is used to figure out which body site to use for AJCC
  • Need a capability to add new staging systems in the future, but it needs to have controls to prevent tweaking AJCC
    • How to model current RI to support such future extension?
slide22

All sarcomas use “grade” in staging

  • Gyno has FIGO, but it’s been mapped to AJCC
    • Substaging for various areas, but still AJCC
    • Gestational trophoblastic tumors are not staged exactly the same way as other areas, as the relay on some clinical lab results; also age, antecedant pregnancy, others
    • Whitmore-Jewitt is Bladder (very old?); use AJCC
  • CNS – Glioma has no staging (diffused or focal); some have WHO system (grade 1-4); rely on pathology report, other standard reports
  • Genetic markers? Not ready to go there
  • Lymphoma - there are masses that can be measured, as well as liquid; TNM doesn’t work the same (you don’t use it); AJCC has taken over Ann Arbor staging system (A and B)
  • IPI – Int’l Prognostic Indicator
slide23

Leukemia – non-solid (skip)\

  • Present DE group don’t practice pediatric oncology
    • Will look at vetting with larger SEG group
    • St. Judes may be a good contact
cancer staging discussion1
Cancer Staging Discussion
  • Source report traceability– expand on topic
    • What would be useful?
      • As long a particular document or image can be selected to link back to staging data (possibly T,M, or N separately), that would be ideal
  • Reporting needs
    • Report to problem list
    • Auto-populate in notes
    • Referrals
  • Scope statement document in progress
slide25

Topic: “restaging”

    • AJCC 7th supports a restaging concept with “r” prefix (cancer returns after disease-free state); will this really be used? Not sounding like it, would be fine with an indicator
    • Other issue: disease progresses (i.e., spreading to other organs/sites)
next steps
Next Steps?
  • Planning for next steps
  • Questions?
  • Big Thank you!