The Technology Exchange for Cancer Health Network

1
The Technology Exchange for Cancer Health Network
(TECH-Net) AHRQ Annual Conference Improving
Healthcare, Improving Lives September 27, 2007
Teresa M. Waters, Ph.D. Department of Preventive
Medicine The University of Tennessee Health
Science Center
2
What is TECH-Net?

• A collaborative, multi-state effort to implement
  a systematic care program to improve cancer
  management in rural communities in the MidSouth
  region
• Tennessee
• North Mississippi
• East Arkansas

3
Why is TECH-Net needed?

• Rapid and significant advances in cancer care do
  not reach poor and rural populations
• Cancer care is complex and involves multiple
  specialists and treatment protocols
• Health care systems in rural areas are poorly
  designed and fragmented
• The Midsouth population has significant unmet
  need in the area of cancer care
• High cancer prevalence
• Large minority population
• Socio-economically disadvantaged

4
(No Transcript)
5
Tennessee Breast Cancer Mortality Rates
6
Mississippi Breast Cancer Mortality Rates
7
Arkansas Breast Cancer Mortality Rates
8
Primary Goal of Project
To determine the extent to which a multi-state
HIT collaborative network can contribute to
MEASUREABLE and SUSTAINABLE improvements in the
cost, safety, and overall quality of cancer care
for rural patients.
9
The Process

• Providing access in rural areas to oncology,
  hematology, and other specialists through the
  dedicated telehealth network of the University of
  Tennessees Health Science Center (UTHSC).
• A distributed electronic health record (EHR)
  integrated with
• Decision support systems
• Online management of cancer protocols
• Electronic orders
• Medication management systems

10
Specific Aim 1

• To implement a collaborative, multi-state Health
  Information Technology System that meets the
  needs of patients, families and providers in a
  rural cancer care setting

11
Specific Aim 2

• To improve access to appropriate care, increase
  the quality and safety of care and achieve better
  health outcomes at equal or lower cost for cancer
  patients in rural communities through an
  integrated Health Information Technology System.

12
Specific Aim 3

• To produce and distribute a generalizeable,
  replicable model for implementing an integrated
  Health Information Technology System for cancer
  care

13
Progress and Results Recruitment and Retention

• Six study sites have recruited patients for the
  study (4 rural, 2 urban)
• Rural patient recruitment is complete (n135),
  exceeding study enrollment goal (125)
• Urban patient recruitment is moving into
  extension year (n74) and we hope to meet our
  recruitment goal in 4 months (125)
• Good study retention only 3 patients withdrew
  from the study (2 rural, 1 urban), and additional
  2 were non-compliant (rural), and 1 transferred
  to another physician (rural)
• 27 patients expired at some point in the study
  (23 rural, 4 urban)

14
Progress and Results Completed Surveys Initial,
6 and 12 Months
15
Aim 1 Progress and Results

• To implement a collaborative, multi-state Health
  Information Technology System that meets the
  needs of patients, families and providers in a
  rural cancer care setting
• Oncology services are provided via Telehealth at
  five sites services augment in-person specialty
  consults allowing cancer patients to have local
  access to specialists for
• follow-up care
• second-opinion consults
• supportive care
• genetic counseling
• Separate EHR systems have been implemented for
  UTCI and UTMG current efforts focusing on
  developing interface

16
Aim 2 Progress and Results

• To improve access to appropriate care, increase
  the quality and safety of care and achieve better
  health outcomes at equal or lower cost for cancer
  patients in rural communities through an
  integrated Health Information Technology System.
• Study has been set up to assess quality, safety,
  health outcomes and cost of rural telehealth
  program using
• Patient Diaries (cost, utilization)
• Chart Abstraction (quality, safety, outcomes)

17
Aim 2 Progress and Results

• Telehealth and EHR infrastructure implemented in
  rural and urban sites
• Patients recruited at rural sites serve as
  intervention group
• Patients recruited at urban sites serve as
  control group
• Quality, safety, outcomes and cost compared
  across treatment and control groups

18
Aim 2 Preliminary Outcomes
19
Aim 2 Preliminary Outcomes
lt 2-fold difference
3-fold difference
Source TECH-Net self-reported patient dairy data.
20
Aim 3 Produce/Distribute Generalizeable/Replicabl
e Model

• Project involves wide range of oncologists
  generalizeable to many clinical practices
• Does not require specific types of telehealth
  equipment or EHR platform more easily replicable
• Greatest obstacles related to creating effective
  partnerships

21
Lessons Learned Keep in Mind Our Ongoing
Challenges!
Find Effective Cooperation
Keep Stepping Over Those Hurdles!
Make It Something Replicable