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Rapid Implementation of a Clinical Workflow Support Tool to Engage Rural Veterans about a Smoking Cessation Trial
Background
Offering participation in clinical trials is a standard of care practice in oncology. It is also considered a quality indicator by various professional cancer societies, including the American Societies of Hematology (ASH) and Clinical Oncology (ASCO). In 2023, VA launched Clinical Cancer Research Services (CCRS) to ensure that all Veterans with cancer can participate in a clinical trial should they choose to do so. Research teams struggle to identify and engage potentially eligible patients. This is a complex process involving eligibility screening, outreach, and personalized support, which frequently involves a manual workflow with inefficiencies, delays, and missed opportunities for patients. To support CCRS’s mission, we used VA Enterprise Cloud (VAEC) to rapidly develop a clinical workflow support application for CCRS team members.
Methods
We used an internally developed framework to rapidly define program aims, provider workflows, opportunities to augment with data products, and lean principles applied to health information technology to design a clinical workflow supporting application. Data products leveraged VAEC’s Summit Data Platform (SDP), an open, multi-cloud platform for ingesting, curating, and managing multi-source VHA data into usable products. User interface was developed in a low code/no code power platform environment, which integrates with SDP and is also available in VAEC.
Results
An initial aim was identified as supporting engagement for the ‘Reaching Rural Cancer Survivors Who Smoke Using Text-based Cessation Interventions’ study. Augmented workflow was identified by meeting principal stakeholders and staff. Data product development involved retrieval of cancer diagnoses from the VA cancer registry system and smoking status from CDW HealthFactors. Rural residence was identified using 2023 Rural-Urban Continuum Codes. Application design, testing and refinement followed. Design to implementation was accomplished over the span of two months: from Aug 5, 2024 to Oct 3, 2024. Over the next seven months, the application identified 2,603 potentially eligible Veterans, and a single navigator using the tool was able to review 456 cases, send 189 study letters, and enroll 5 Veterans.
Conclusions
Clinical workflow support tools that leverage cloud infrastructure such as VAEC and Summit Data Platform can improve system efficiencies and increase access to clinical trials.
Background
Offering participation in clinical trials is a standard of care practice in oncology. It is also considered a quality indicator by various professional cancer societies, including the American Societies of Hematology (ASH) and Clinical Oncology (ASCO). In 2023, VA launched Clinical Cancer Research Services (CCRS) to ensure that all Veterans with cancer can participate in a clinical trial should they choose to do so. Research teams struggle to identify and engage potentially eligible patients. This is a complex process involving eligibility screening, outreach, and personalized support, which frequently involves a manual workflow with inefficiencies, delays, and missed opportunities for patients. To support CCRS’s mission, we used VA Enterprise Cloud (VAEC) to rapidly develop a clinical workflow support application for CCRS team members.
Methods
We used an internally developed framework to rapidly define program aims, provider workflows, opportunities to augment with data products, and lean principles applied to health information technology to design a clinical workflow supporting application. Data products leveraged VAEC’s Summit Data Platform (SDP), an open, multi-cloud platform for ingesting, curating, and managing multi-source VHA data into usable products. User interface was developed in a low code/no code power platform environment, which integrates with SDP and is also available in VAEC.
Results
An initial aim was identified as supporting engagement for the ‘Reaching Rural Cancer Survivors Who Smoke Using Text-based Cessation Interventions’ study. Augmented workflow was identified by meeting principal stakeholders and staff. Data product development involved retrieval of cancer diagnoses from the VA cancer registry system and smoking status from CDW HealthFactors. Rural residence was identified using 2023 Rural-Urban Continuum Codes. Application design, testing and refinement followed. Design to implementation was accomplished over the span of two months: from Aug 5, 2024 to Oct 3, 2024. Over the next seven months, the application identified 2,603 potentially eligible Veterans, and a single navigator using the tool was able to review 456 cases, send 189 study letters, and enroll 5 Veterans.
Conclusions
Clinical workflow support tools that leverage cloud infrastructure such as VAEC and Summit Data Platform can improve system efficiencies and increase access to clinical trials.
Background
Offering participation in clinical trials is a standard of care practice in oncology. It is also considered a quality indicator by various professional cancer societies, including the American Societies of Hematology (ASH) and Clinical Oncology (ASCO). In 2023, VA launched Clinical Cancer Research Services (CCRS) to ensure that all Veterans with cancer can participate in a clinical trial should they choose to do so. Research teams struggle to identify and engage potentially eligible patients. This is a complex process involving eligibility screening, outreach, and personalized support, which frequently involves a manual workflow with inefficiencies, delays, and missed opportunities for patients. To support CCRS’s mission, we used VA Enterprise Cloud (VAEC) to rapidly develop a clinical workflow support application for CCRS team members.
Methods
We used an internally developed framework to rapidly define program aims, provider workflows, opportunities to augment with data products, and lean principles applied to health information technology to design a clinical workflow supporting application. Data products leveraged VAEC’s Summit Data Platform (SDP), an open, multi-cloud platform for ingesting, curating, and managing multi-source VHA data into usable products. User interface was developed in a low code/no code power platform environment, which integrates with SDP and is also available in VAEC.
Results
An initial aim was identified as supporting engagement for the ‘Reaching Rural Cancer Survivors Who Smoke Using Text-based Cessation Interventions’ study. Augmented workflow was identified by meeting principal stakeholders and staff. Data product development involved retrieval of cancer diagnoses from the VA cancer registry system and smoking status from CDW HealthFactors. Rural residence was identified using 2023 Rural-Urban Continuum Codes. Application design, testing and refinement followed. Design to implementation was accomplished over the span of two months: from Aug 5, 2024 to Oct 3, 2024. Over the next seven months, the application identified 2,603 potentially eligible Veterans, and a single navigator using the tool was able to review 456 cases, send 189 study letters, and enroll 5 Veterans.
Conclusions
Clinical workflow support tools that leverage cloud infrastructure such as VAEC and Summit Data Platform can improve system efficiencies and increase access to clinical trials.
Anchors Aweigh, Clinical Trial Navigation at the VA!
Background
Despite the benefit of cancer clinical trials (CTs) in increasing medical knowledge and broadening treatment options, VA oncologists face challenges referring or enrolling Veterans in CTs including identifying appropriate CTs and navigating the referral process especially for non-VA CTs. To address these challenges, the VA National Oncology Program (NOP) provided guidance regarding community care referral for CT participation and established the Cancer Clinical Trial Nurse Navigation (CTN) service.
Methods
Referrals to CTN occur via Precision Oncology consult or email to [email protected]. The CT nurse navigator educates Veterans about CTs, identifies CTs for Veterans based on disease and geographic area, provides written summaries to Veterans and VA oncologists, and facilitates communication between clinical and research teams. Descriptive statistics were used to summarize characteristics of Veterans referred to CTN and results of the CTN searches. A semi-structured survey was used to assess satisfaction from 50 VA oncologists who had used the CTN service.
Results
Between June 2023 and May 2024, 72 Veterans were referred to CTN. Patient characteristics include male (94%), non-rural (65%), median age 66.5 (range 27-80), self-reported race as White (74%) and Black (22%), cancer type as solid tumor (73%) and blood cancer (27%). The median number of CTs found for each Veteran was two (range 0 - 12). No referred Veterans enrolled in CTs, with the most common causes being CT ineligibility and desire to receive standard therapy in the VA. Twenty oncologists were educated about NOP CT guidance. The response rate to the feedback survey was modest (34%) but 94% of survey respondents rated their overall satisfaction as highly satisfied or satisfied.
Conclusions
The CTN assists Veterans and VA oncologists in connecting with CTs. The high satisfaction rate and ability to reach a racially and geographically diverse Veteran population are measures of early program success. By lowering the barriers for VA oncologists to consider CTs for their patients, the CTN expects increased and earlier referrals of Veterans, which may improve CT eligibility and participation. Future efforts to provide disease-directed education about CTs to Veterans and VA oncologists is intended to encourage early consideration of CTs.
Background
Despite the benefit of cancer clinical trials (CTs) in increasing medical knowledge and broadening treatment options, VA oncologists face challenges referring or enrolling Veterans in CTs including identifying appropriate CTs and navigating the referral process especially for non-VA CTs. To address these challenges, the VA National Oncology Program (NOP) provided guidance regarding community care referral for CT participation and established the Cancer Clinical Trial Nurse Navigation (CTN) service.
Methods
Referrals to CTN occur via Precision Oncology consult or email to [email protected]. The CT nurse navigator educates Veterans about CTs, identifies CTs for Veterans based on disease and geographic area, provides written summaries to Veterans and VA oncologists, and facilitates communication between clinical and research teams. Descriptive statistics were used to summarize characteristics of Veterans referred to CTN and results of the CTN searches. A semi-structured survey was used to assess satisfaction from 50 VA oncologists who had used the CTN service.
Results
Between June 2023 and May 2024, 72 Veterans were referred to CTN. Patient characteristics include male (94%), non-rural (65%), median age 66.5 (range 27-80), self-reported race as White (74%) and Black (22%), cancer type as solid tumor (73%) and blood cancer (27%). The median number of CTs found for each Veteran was two (range 0 - 12). No referred Veterans enrolled in CTs, with the most common causes being CT ineligibility and desire to receive standard therapy in the VA. Twenty oncologists were educated about NOP CT guidance. The response rate to the feedback survey was modest (34%) but 94% of survey respondents rated their overall satisfaction as highly satisfied or satisfied.
Conclusions
The CTN assists Veterans and VA oncologists in connecting with CTs. The high satisfaction rate and ability to reach a racially and geographically diverse Veteran population are measures of early program success. By lowering the barriers for VA oncologists to consider CTs for their patients, the CTN expects increased and earlier referrals of Veterans, which may improve CT eligibility and participation. Future efforts to provide disease-directed education about CTs to Veterans and VA oncologists is intended to encourage early consideration of CTs.
Background
Despite the benefit of cancer clinical trials (CTs) in increasing medical knowledge and broadening treatment options, VA oncologists face challenges referring or enrolling Veterans in CTs including identifying appropriate CTs and navigating the referral process especially for non-VA CTs. To address these challenges, the VA National Oncology Program (NOP) provided guidance regarding community care referral for CT participation and established the Cancer Clinical Trial Nurse Navigation (CTN) service.
Methods
Referrals to CTN occur via Precision Oncology consult or email to [email protected]. The CT nurse navigator educates Veterans about CTs, identifies CTs for Veterans based on disease and geographic area, provides written summaries to Veterans and VA oncologists, and facilitates communication between clinical and research teams. Descriptive statistics were used to summarize characteristics of Veterans referred to CTN and results of the CTN searches. A semi-structured survey was used to assess satisfaction from 50 VA oncologists who had used the CTN service.
Results
Between June 2023 and May 2024, 72 Veterans were referred to CTN. Patient characteristics include male (94%), non-rural (65%), median age 66.5 (range 27-80), self-reported race as White (74%) and Black (22%), cancer type as solid tumor (73%) and blood cancer (27%). The median number of CTs found for each Veteran was two (range 0 - 12). No referred Veterans enrolled in CTs, with the most common causes being CT ineligibility and desire to receive standard therapy in the VA. Twenty oncologists were educated about NOP CT guidance. The response rate to the feedback survey was modest (34%) but 94% of survey respondents rated their overall satisfaction as highly satisfied or satisfied.
Conclusions
The CTN assists Veterans and VA oncologists in connecting with CTs. The high satisfaction rate and ability to reach a racially and geographically diverse Veteran population are measures of early program success. By lowering the barriers for VA oncologists to consider CTs for their patients, the CTN expects increased and earlier referrals of Veterans, which may improve CT eligibility and participation. Future efforts to provide disease-directed education about CTs to Veterans and VA oncologists is intended to encourage early consideration of CTs.