North East ONCOLOGY News
Volume 9 Issue 1 August 2019 IN THIS ISSUE
Ontario Health Care Reform...... 1 Ontario Health Care Reform Northeast Oncology Conference: Save the Date ...... 1 This Spring many of us have been hearing about Recently Cancer Care Ontario’s CEO Michael the legislative changes to Ontario’s health care Sherar met with his new board chair Bill Improving Access to system through the formation of Ontario Health, Hatanaka to outline CCO’s approach to health Radiation Therapy one single health agency that will oversee health system improvement in cancer care, renal for Northeastern care delivery, improve clinical guidance and care and palliative care. In particular he took Ontario Breast Cancer provide support for providers to ensure better the opportunity to highlight the importance of Patients...... 2 quality care for patients. Ontario Health will regional clinical leadership as an essential enfold several provincial agencies, including link to ensure broad system plans are Cancer Care Ontario (CCO), and plans to deliver implemented on the frontlines of care across It’s Time for the Fecal health care through integrated care delivery the province in a standardized way. One of Immunochemical Test ....3 systems which are being referred to as Ontario our regional clinical leaders, Dr. Amanda Hey Health Teams. Primary care will be pivotal to will be retiring at the end of August and her this planning and these new service delivery role as a Regional Primary Care Lead has The Supportive Care approaches. been pivotal to what we have accomplished Program...... 4 across our regional cancer system. I would Ontario Health is expected to build upon the like to formally recognize Dr. Hey’s significant same standards of excellence developed by contributions to how effectively cancer many existing agencies across the health prevention and screening have been adopted INSERTS: care system, including those which have been across the region, both in primary care and in developed by CCO and spread through the Indigenous communities and organizations. work of the Northeast Cancer Centre over the Primary care clinical leadership will continue • Peer Leaders Help years. For many years in our Regional Cancer to be important to us in regional cancer You Use Your EMR for Program, we have benefited from applying a care and equally important with our shifting Better Cancer Care systematic approach to spreading evidence- health care landscape. I call on each of you • OntarioMD Case based standards, providing clinical guidance to consider how your clinical leadership can Study and support to health care providers throughout positively influence a better health system for the northeast so that northerners can expect our future generations, particularly as Ontario • ONE®ID and Cancer to receive the same high quality cancer care Health Teams develop in the coming year. Care Ontario’s regardless of where they live. This level of quality Screening Activity has been achieved through engaging Provincial Maureen McLelland, BScN, MHSc, CHE Report: Access Made and Regional Clinical Leads to develop and Regional Vice President, Northeast Cancer Care Easier spread best practices and to monitor their Vice President, Social Accountability adoption. Health Sciences North
Together Towards Tomorrow Emerging Trends in Cancer Care
Save the Date: Friday November 15th 2019 There is significant clinical interest in Canada in further Improving Access to shortening radiotherapy duration. A clinical trial testing a Radiation Therapy for course of therapy of only one week in duration has been proposed and is under development. We are hopeful that Northeastern Ontario in the future such a trial will permit us an opportunity to offer Breast Cancer Patients some breast cancer patients in northeastern Ontario radiation therapy in just one week!
Across Ontario, the percentage of cancer patients receiving Optimizing the use of Ontario Telemedicine Network: various cancer therapies is tracked to ensure that Ontarians We are also aware that travelling for a new patient consultation are receiving equitable and appropriate health care. This to meet with a radiation oncologist can be onerous depending data has demonstrated that breast cancer patients living on the distance from the cancer centre. For this reason we in the North East LHIN are receiving radiation at a lower have now adopted a new standard whereby all breast cancer rate than southern Ontario patients. This effect increases patients living more than 100 km from our centres are offered with increasing distance to our radiation facilities (Sudbury the opportunity of having their first consultation via the Ontario and Sault Ste. Marie) suggesting that a patient’s distance Telemedicine Network (OTN). Patients are therefore no from a treatment facility is presenting a barrier to receiving longer required to travel vast distances to find out if radiation appropriate radiation therapy. In order to attempt to is recommended for them, what the pros and cons of such a improve care for patients in northeastern Ontario, the treatment approach are and how long the treatment will take. Northeast Cancer Centre (NECC) has taken action to make In addition, when they do come to one of our two northeastern breast radiotherapy more accessible and less disruptive for Ontario radiation facilities (Sudbury and Sault Ste. Marie) we patients. can ensure that the trip is efficient with all necessary planning steps accomplished, further reducing the number of trips the Shortened treatment duration: patient will require. Standard breast radiotherapy was previously delivered over five to six weeks. This standard was in place for We are hopeful that increased awareness of the availability of many decades helping to decrease recurrence rates and OTN for the initial consultation between radiation oncologists reduce the number of patients requiring a mastectomy. A and breast cancer patients combined with shorter treatment pivotal Canadian trial established that equally effective duration will provide greater choice and access for breast therapy could be delivered in only three weeks when cancer patients in northeastern Ontario. treating the breast alone, establishing a new standard of Dr. Andrew Pearce care in Canada for breast-only treatment. Newer data Head of Service, Radiation Oncology has shown that this shortened treatment duration is also Northeast Cancer Centre safe in patients receiving treatment to the regional lymph Assistant Professor, Northern Ontario School of Medicine nodes in addition to the breast. The NECC has therefore now expanded this three week standard to include patients receiving radiation to the breast and regional lymph nodes. This has effectively decreased the duration of therapy for the vast majority of our breast cancer patients to only three weeks. NorthNorth East East ONCOLOGY ONCOLOGY News News
It’s Time for the Fecal Immunochemical Test On June 24, 2019, the ColonCancerCheck (CCC) program launched the fecal immunochemical test (FIT) as the recommended screening test for people at average risk of colorectal cancer (CRC). When compared to the guaiac fecal occult blood test (gFOBT), FIT has many beneficial characteristics, which is anticipated to lead to a decrease in both the incidence AND mortality of colorectal cancer in Ontario. FIT characteristics Better test usability Increased sensitivity • tube designed for easy sampling • 82% FIT vs 38% gFOBT for one-time testing1 • only one sample required • no dietary or medication restrictions FIT process outcomes Increased participation Higher positivity rate • 16% increase relative to gFOBT2 • CCC gFOBT positivity rate: 4.1%4 • participants prefer FIT over average-risk colonoscopy3 • CCC FIT positivity rate is expected to be higher than gFOBT1 Abnormal FIT colonoscopy management • Repeating the FIT after an abnormal FIT or gFOBT is not appropriate and can lead to delays in diagnosis and treatment. Requests to repeat FIT after an abnormal FIT result will not be accepted by LifeLabs® • CCC benchmark: abnormal FIT patients should receive follow-up colonoscopy within eight weeks More cancers and high-risk adenomas detected
• FIT has been shown to detect twice as many colorectal cancers and high-risk adenomas (HRA) as gFOBT2 • Abnormal FIT colonoscopy has a higher diagnostic yield for CRC and HRA than average-risk colonoscopy5 ANTICIPATED DECREASE IN CRC INCIDENCE AND MORTALITY 1,2,3,4,5 References available upon request. Submit request to [email protected]
All family physicians and nurse practitioners were mailed a Q: If my patient is in the office before the two-year FIT CCC package providing a number of resources, including testing interval, can I order the test a bit early? a NEW LifeLabs® FIT requisition for CCC screening and a sample FIT kit. If you didn’t receive the package contact A: Although the program’s recommended screening interval [email protected] or go to the FIT resource remains two years, LifeLabs® will accept FIT requisitions 21 hub at cancercareontario.ca/FITHub. months after a patient’s last stool-based test. This provides some flexibility by allowing a FIT requisition to be submitted The FIT resource hub also houses a “Frequently Asked to LifeLabs® slightly before a patient’s two-year screening Questions” document. Here are a few practice tips: anniversary.
Q: Can I access the FIT requisition in my electronic There are two articles inserted in this issue of NEON that medical record (EMR)? may be of interest to primary care providers. The first is part two of a series authored by Dr. Darren Larsen of A: The FIT requisition is available in all OntarioMD- OntarioMD highlighting Peer Leaders. The other article certified EMRs. Please add the FIT requisition to your features updated information on registering for ONE®ID and library of custom forms in your EMR. If you are unable accessing Cancer Care Ontario’s (CCO) Screening Activity to find the requisition in your EMR, you can manually Report. upload it or e-mail [email protected] for support. And finally, thank you to my primary care colleagues for your enduring commitment to offering evidence-based cancer screening to your patients in order to reduce the burden of cancer in northeastern Ontario. Dr. Amanda Hey Regional Primary Care Lead North East Regional Cancer Program North East ONCOLOGY News
The Supportive Care Program Welcomes Dr. Scott Carmichael
It has been a privilege to start working as the psychiatric I have had a passion for psychosocial oncology work since IN THIS ISSUE consultant for the Supportive Care Program at the I had the opportunity to train at the Psychosocial Oncology Northeast Cancer Centre. I provide psychiatric consultation Program at The Ottawa Hospital Cancer Centre during my and short-term follow up as indicated to patients that residency. have been evaluated by a social worker within the Supportive Care Program. Working within the Supportive I was born and raised in North Bay and am excited to be living Care Program allows for a collaborative approach with in northern Ontario again. I look forward to working with my knowledgeable and empathic social workers. We strive to colleagues within the Northeast Cancer Centre to optimize the address the multitude of biopsychosocial factors that can mental health of our patients. have an impact on mental health during the different phases Dr. Scott Carmichael of a patient’s cancer journey. Psychiatrist, Supportive Care Program I completed my MD and psychiatric residency at the North East Regional Cancer Program University of Ottawa. I worked at The Ottawa Hospital – Civic Campus doing acute inpatient, outpatient and consult liaison work before relocating to Sudbury in November 2018.
The Supportive Care Program: About Us Patients can be seen on an individual basis or attend an educational session. Available classes include: The Supportive Care Program helps individuals and families in northeastern Ontario navigate the psychological, • New Patient and Caregiver Orientation emotional, social, spiritual and physical concerns caused by • Fighting Cancer-Related Fatigue cancer. • Breast Cancer Information Session • Lymphedema Our program consists of a multidisciplinary team that includes social workers, dietitians, physiotherapists, Patients, caregivers, as well as health care professionals speech language pathologists, a psychiatrist, a Medicine can refer to our program by calling 705-522-6237, ext. 2175. Lodge Keeper, a navigator of Indigenous health, and an Most services are available in French and English Indigenous Engagement Liaison Worker as well as a and available closer to home through the Ontario Telemedicine Palliative Symptom Management Team. Network. More about the Palliative Symptom Management Clinic
The Palliative Symptom Management Clinic (PSMC) serves For patients with very complex needs, or without a primary care adults afflicted with life-limiting cancers whose prognosis is provider, a take-over care model is also an option. Primary care estimated to be less than one year. The service is available providers who wish to increase their comfort and knowledge of to patients and their caregivers who have palliative goals. palliative and end-of-life care are encouraged to work with the Primary care providers managing cancer patients with PSMC. To obtain a copy of the referral form, please call 705- metastatic disease are welcome to request a one-time consult 522-6237 ext. 2522. for their patients. There is also an option to share care.
NORTH EAST ONCOLOGY NEWS PRODUCTION TEAM North East Oncology News is a triannual publication from the Northeast Cancer
Centre providing evidence-based guidance, and clinical and operational Editor: Maureen McLelland Assistant Editor: Dr. Amanda Hey updates of interest with a focus on primary care in northeastern Ontario. Production Coordinator: Merci Miron-Black Production Assistant: Rhonda Lamothe References used for this issue of North East Oncology News are available upon request from the editor. Articles may be reprinted without permission, provided 41 Ramsey Lake Road - Sudbury, ON P3E 5J1 the source is acknowledged. Phone: 705-522-6237 - Fax: 705-671-5496 [email protected] Available online at www.hsnsudbury.ca/NECCprimarycareresources North East ONCOLOGY News Insert: Volume 9 Issue 1
Peer Leaders Help You Use Your EMR
for Better Cancer Care Part two of a guest series by OntarioMD
The Screening Activity Report (SAR) was created by Our province-wide network of Peer Leaders includes Cancer Care Ontario (CCO) as a supplementary electronic specialists, family physicians, nurses and clinic managers who tool to support patient enrolment model (PEM) primary care have a range of experience, different areas of clinical focus and physicians in improving their practice breast, cervical and specialties, and knowledge of different EMRs. They understand colorectal cancer screening rates and appropriate follow-up. practice pressures and how physicians work and can introduce you to quick tips and EMR-integrated tools that enhance your If you are using an electronic medical record (EMR) in your ability to provide efficient and effective care for patients who practice, you understand the clinical value this valuable have, or are at risk of, cancer. patient management tool brings to your practice and your workflow. Your EMR can make you more efficient and Dr. Mario Elia is a family physician practicing in London. He proactive in your care – and have a direct impact on your has been an OntarioMD Peer Leader since 2015, sharing patients’ health. knowledge with his peers on how he uses his TELUS Practice Solutions EMR to enhance his practice’s goals and offer In the February 2019 newsletter, we told you about better patient care. This issue’s insert outlines his three- OntarioMD’s role in developing and implementing digital step framework for using your EMR to identify and track health tools, such as Health Report Manager (HRM) and the cancer patients for follow up. This is just one example of how Ontario Laboratories Information System (OLIS). Your ability OntarioMD Peer Leaders can help you tap into your EMR’s to effectively screen and follow-up with patients who have potential for better cancer-related patient care. You can request or are at risk of developing cancer depend on a number of a consultation with a Peer Leader about any aspect of your factors including timely hospital reports and lab results – and EMR or other digital health tools by emailing: OntarioMD has helped thousands of EMR-connected clinicians [email protected] do these things by connecting them to HRM and OLIS. Of course, as with any piece of technology, the value you get from your EMR is directly related to how well you understand it. At its core, an EMR is simply a tool for entering and storing patient data. The key to optimizing Peer Leaders are also the full power of your EMR – as well as the wide range of available for consultation at: EMR-integrated tools – is in making sure you are entering patient data in a consistent, accurate manner. Once you’re confident in the accuracy and quality of your data, the • OntarioMD’s EMR: Every Step Conference on next step is to use your EMR’s built-in functionalities for September 26, 2019 in Toronto identifying patients who need screening or follow-up care. OntarioMD can help you with this. While we have developed • On the Road with OntarioMD regional educational a strong reputation as a trusted health care technology seminars development and delivery partner, perhaps our biggest value lies in the personalized clinician support offered by our field staff. We provide in-depth, hands-on support for your practice and patient care goals through our EMR Practice Enhancement Program (EPEP). And OntarioMD Peer Leaders provide as-needed complimentary consulting services to clinician practices at a mutually convenient time that can Dr. Darren Larsen lead to more efficient EMR use and workflow, optimization Chief Medical Officer of existing EMR functions and access to additional ones, OntarioMD improved clinical decision support, and much more. OntarioMD Case Study: Harnessing the power of EMRs for e ective cancer care follow-up
THE CHALLENGE Cancer care follow-up in Ontario is increasingly being embraced by primary care providers as part of comprehensive care delivery. During a stressful time in their lives, patients are tasked with navigating the transition from specialist care to primary care. Physician practices need to establish formalized processes that ensure high quality and evidence-based follow-up visits. These processes must meet current standards of care, be easy to update as needed to reflect new evidence, and integrate into busy practices – ideally without adding to the administrative burden physicians face. With Canada’s population continuing to age in the coming years, the number of new cancer cases is expected to grow. Developing a program for follow-up care of cancer patients can save lives. Many physician’s o ces have programs in place that tap into the power of their electronic medical record (EMR) to monitor a range of conditions including cancer screening. However, similar programs often aren’t in place to facilitate cancer survivor follow-up.
BACKGROUND OntarioMD has been supporting community-based clinicians to implement and use EMRs since 2004. Over 17,000 Ontario physicians and more than 1,000 nurse practitioners are using an EMR to care for more than 10 million Ontarians. OntarioMD is building on that success by o ering products and services designed to help practices optimize their EMR use. OntarioMD recognizes that clinicians need proper support to adopt new technologies, address changes to workflow, and become experienced users. With this in mind, we o er the Peer Leader Program, through which physicians, nurses and clinic managers can access the EMR expertise and support of their peers. How your EMR and Peer Leader support can help Dr. Mario Elia is a family physician from London, Ontario and adjunct professor in the Department of Family Medicine at Western University. He’s also been an OntarioMD Physician Peer Leader since 2015. As a Physician Peer Leader, Dr. Elia has been able to support his fellow physicians by sharing his own successes with EMRs and helping to develop plans that lead to tangible practice improvements. In his work advising physicians on using their EMR for e ective cancer care follow-up, Dr. Elia proposes a three-step framework that can be easily integrated into existing processes, and updated as needed. 1. Determine which cancers to track: Dr. Elia suggests OntarioMD’s Peer Leader team includes starting with several prevalent forms (for example, lung, breast, colorectal, prostate, bladder), and adding others GPs/ CLINIC as appropriate for your practice. Create standard terms 49 SPECIALISTS 9 MANAGERS with which to label each cancer in your EMR – such as “breast ca” for breast cancer, or link the diagnoses to an ICD-9, ICD-10 or SNOMED CT code. And, determine where this information should be entered. Then, create a glossary 2 NURSES of these standards and make every EMR user in your practice aware of them, to ensure terms are entered uniformly for each patient.
2. Create a targeted database of patients: Search your EMR for patients who have been diagnosed with each type of cancer. This will require some time and creativity, as you’ll need to think of every possible way you’ve labelled each cancer in the past (for example, you may DESIGNED TO SERVE have previously labelled colorectal cancer patients as “rectal ca”, or “ca colon”). Dr. Elia has a glossary of useful 17,000+ PHYSICIANS AND THEIR STAFF searches, which he shares with Peer Leader Program participants. As you find patients, make sure to re-label WITH ENHANCING EMR USE their record using your new standard cancer terms.
3. Determine appropriate follow-up processes: Identify follow-up requirements (imaging, bloodwork, What Ontario’s physicians are saying annual check-up) for each type of cancer. Then, determine how you want to use the data in your EMR. You could “I really appreciated Dr. Elia’s knowledge and take a passive approach by setting reminders that would ability to relay relevant and practical information.” show up on routine reports (prostate cancer patients who are due for a PSA test, for example). Or, you might Dr. Henry Ho actively search your patient database at regular intervals Family Physician, Yonge Sheppard Medical – such as monthly or annually – for follow-up indicators. “Dr. Elia was thorough, taught at a pace I This framework holds immense benefits for your practice. could digest, and gave me tricks and tips that In fact, it can be repeated for pre-cancerous conditions, were practical.” which is another important group for follow-up. But the Dr. Cathy Faulds set-up process can be a lot of work. Rather than Family Physician, London Family Health Team attempting to do it all at once, establish a project plan, and delegate tasks among physicians or other team members in your o ce.
Contact General Inquiries If you’d like to request the advice of a Peer Leader to OntarioMD Inc. learn how to leverage your certified EMR cancer care 150 Bloor St. West, Suite 900, Toronto, Ontario M5S 3C1 follow-up or other practice improvements, please contact the OntarioMD Peer Leader Program at Phone: 416.623.1248 | Toll-free: 1.866.744.8668 [email protected] Fax: 416.623.1249 | Email: [email protected] or click here to request a Peer Leader. Web: www.ontariomd.ca
The information in this case study is intended only as an example. Other Peer Leaders and colleagues may employ di erent approaches. The views expressed in this publication are the views of OntarioMD and do not necessarily reflect those of the Province. North East ONCOLOGY News Reprinted from Volume 8 Issue 2 Updated May 2019
Gaining SAR access once registered for ONE®ID ® ONE ID and Cancer Care Once registered for ONE®ID, the SAR can be added to your Ontario’s Screening Activity account remotely by contacting and providing your name, CPSO number and ONE®ID login to one of the three following Report: Access Made Easier entities:
1. If available, an LRA working in your health care setting The Screening Activity Report (SAR) was created by 2. eHealth Ontario Registration Agents: Cancer Care Ontario (CCO) as a supplementary electronic [email protected] tool to support patient enrolment model (PEM) primary care 3. Northeast Cancer Centre’s Primary Care Outreach physicians in improving their practice breast, cervical and Coordinator and LRA, Merci Miron-Black (see below) colorectal cancer screening rates and appropriate follow-up. ® ® The addition of the SAR to your ONE ID account is confirmed The SAR is accessed through ONE ID, eHealth Ontario’s by email. digital identity and authentication system, which allows health care professionals to securely access digital health services with a single user name and password. In addition Using the SAR to the SAR, digital health services accessed through CCO offers a number of useful SAR support ONE®ID include: documents and links to pertinent ONE®ID pages at: • ONE®Mail www.cancercareontario.ca/SAR. The site also provides an • Ontario Telemedicine Network (OTN) Hub “Access your SAR” tab which provides an efficient pathway to • ConnectingOntario ClinicalViewer accessing the SAR, taking you through the ONE®ID login page A recent partnership with the College of Physicians and directly to the SAR. Surgeons of Ontario (CPSO) has simplified the ONE®ID registration process by eliminating the need to contact Authorizing a delegate for the SAR and provide identity documents to an eHealth Ontario Local A delegate is a member of your primary care team (e.g. a nurse, Registration Authority (LRA). an office manager or a clinic staff member) who is authorized ONE®ID registration for CPSO members to access your SAR. A delegate is set up with their own unique ONE®ID account and is given permission from a physician 1. Go to the CPSO website members page and log in to download and view the report. By authorizing delegates, using your CPSO account credentials, then scroll to the tasks involved in cancer screening can be shared among the bottom of the “Welcome to CPSO Online” page and team members. You can add or manage a delegate from your click on “Get Your eHealth ONE ID”. ONE®ID account. 2. On the “Getting an eHealth Ontario ONE ID” page, review the contents and agree to the consent statement, then click on the “Register for ONE ID” button. 3. You will be directed to the ONE®ID site to complete the registration, involving reviewing your pre-populated personal profile based on CPSO information, and selecting security challenge questions and a password. You will then be provided with a login ID. 4. If you have any issues logging in to your ONE®ID account (e.g. the account is locked), call the eHealth Ontario Service Desk available 24/7 at 1-866-250-1554.
For additional SAR support that would include SAR access, use and delegate, please feel free to contact: Merci Miron-Black Regional Coordinator, Primary Care Outreach | North East Regional Cancer Program [email protected] or 705-522-6237 ext. 2537 Dr. Amanda Hey Regional Primary Care Lead North East Regional Cancer Program