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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.
Access to Germline Genetic Testing through Clinical Pathways in Veterans With Prostate Cancer
Background
Germline genetic testing (GGT) is essential in prostate cancer care, informing clinical decisions. The Veterans Affairs National Oncology Program (VA NOP) recommends GGT for patients with specific risk factors in non-metastatic prostate cancer and all patients with metastatic disease. Understanding GGT access helps evaluate care quality and guide improvements. Since 2021, VA NOP has implemented pathway health factor (HF) templates to standardize cancer care documentation, including GGT status, enabling data extraction from the Corporate Data Warehouse (CDW) rather than requiring manual review of clinical notes. This work aims to evaluate Veterans’ access to GGT in prostate cancer care by leveraging pathway HF templates, and to assess the feasibility of using structured electronic health record (EHR) data to monitor adherence to GGT recommendations.
Methods
Process delivery diagrams (PDDs) were used to map data flow from prostate cancer clinical pathways to the VA CDW. We identified and categorized HFs related to prostate cancer GGT through the computerized patient record system (CPRS). Descriptive statistics were used to summarize access, ordering, and consent rates.
Results
We identified 5,744 Veterans with at least one prostate cancer GGT-relevant HF entered between 02/01/2021 and 12/31/2024. Of these, 5,125 (89.2%) had access to GGT, with 4,569 (89.2%) consenting to or having GGT ordered, while 556 (10.8%) declined testing. Among the 619 (10.8%) Veterans without GGT access, providers reported plans to discuss GGT in the future for 528 (85.3%) patients, while 91 (14.7%) were off pathway.
Conclusions
NOP-developed HF templates enabled extraction of GGT information from structured EHR data, eliminating manual extraction from clinical notes. We observed high GGT utilization among Veterans with pathway-entered HFs. However, low overall HF utilization may introduce selection bias. Future work includes developing a Natural Language Processing pipeline using large language models to automatically extract GGT information from clinical notes, with HF data serving as ground truth.
Background
Germline genetic testing (GGT) is essential in prostate cancer care, informing clinical decisions. The Veterans Affairs National Oncology Program (VA NOP) recommends GGT for patients with specific risk factors in non-metastatic prostate cancer and all patients with metastatic disease. Understanding GGT access helps evaluate care quality and guide improvements. Since 2021, VA NOP has implemented pathway health factor (HF) templates to standardize cancer care documentation, including GGT status, enabling data extraction from the Corporate Data Warehouse (CDW) rather than requiring manual review of clinical notes. This work aims to evaluate Veterans’ access to GGT in prostate cancer care by leveraging pathway HF templates, and to assess the feasibility of using structured electronic health record (EHR) data to monitor adherence to GGT recommendations.
Methods
Process delivery diagrams (PDDs) were used to map data flow from prostate cancer clinical pathways to the VA CDW. We identified and categorized HFs related to prostate cancer GGT through the computerized patient record system (CPRS). Descriptive statistics were used to summarize access, ordering, and consent rates.
Results
We identified 5,744 Veterans with at least one prostate cancer GGT-relevant HF entered between 02/01/2021 and 12/31/2024. Of these, 5,125 (89.2%) had access to GGT, with 4,569 (89.2%) consenting to or having GGT ordered, while 556 (10.8%) declined testing. Among the 619 (10.8%) Veterans without GGT access, providers reported plans to discuss GGT in the future for 528 (85.3%) patients, while 91 (14.7%) were off pathway.
Conclusions
NOP-developed HF templates enabled extraction of GGT information from structured EHR data, eliminating manual extraction from clinical notes. We observed high GGT utilization among Veterans with pathway-entered HFs. However, low overall HF utilization may introduce selection bias. Future work includes developing a Natural Language Processing pipeline using large language models to automatically extract GGT information from clinical notes, with HF data serving as ground truth.
Background
Germline genetic testing (GGT) is essential in prostate cancer care, informing clinical decisions. The Veterans Affairs National Oncology Program (VA NOP) recommends GGT for patients with specific risk factors in non-metastatic prostate cancer and all patients with metastatic disease. Understanding GGT access helps evaluate care quality and guide improvements. Since 2021, VA NOP has implemented pathway health factor (HF) templates to standardize cancer care documentation, including GGT status, enabling data extraction from the Corporate Data Warehouse (CDW) rather than requiring manual review of clinical notes. This work aims to evaluate Veterans’ access to GGT in prostate cancer care by leveraging pathway HF templates, and to assess the feasibility of using structured electronic health record (EHR) data to monitor adherence to GGT recommendations.
Methods
Process delivery diagrams (PDDs) were used to map data flow from prostate cancer clinical pathways to the VA CDW. We identified and categorized HFs related to prostate cancer GGT through the computerized patient record system (CPRS). Descriptive statistics were used to summarize access, ordering, and consent rates.
Results
We identified 5,744 Veterans with at least one prostate cancer GGT-relevant HF entered between 02/01/2021 and 12/31/2024. Of these, 5,125 (89.2%) had access to GGT, with 4,569 (89.2%) consenting to or having GGT ordered, while 556 (10.8%) declined testing. Among the 619 (10.8%) Veterans without GGT access, providers reported plans to discuss GGT in the future for 528 (85.3%) patients, while 91 (14.7%) were off pathway.
Conclusions
NOP-developed HF templates enabled extraction of GGT information from structured EHR data, eliminating manual extraction from clinical notes. We observed high GGT utilization among Veterans with pathway-entered HFs. However, low overall HF utilization may introduce selection bias. Future work includes developing a Natural Language Processing pipeline using large language models to automatically extract GGT information from clinical notes, with HF data serving as ground truth.