Domain Profile Vendors Actors

IT Infrastructure (ITI)

PIX, PIXv3 CareEvolution, Tiani-Cisco PIX ManagerPDQ CareEvolution, Tiani-Cisco PDS Server

XCA, XCPD CareEvolution, Tiani-Cisco, Epic Initiating Gateway, Responding Gateway, Registry

XDS-b CareEvolution, Tiani-Cisco, Epic Document Registry, Document RepositoryMPQ CareEvolution, CDC (eMaRC) Document Consumer

XDW (Referral) Epic, GE Healthcare Content Creator

Radiology (RAD) XDS-I.b Epic, GE Healthcare Document Source, Consumer (Report)Patient Care

Coordination (PCC)XDS-MS Epic, GE Healthcare Content Creator, Consumer

Quality, Research & Public Health

(QRPH)

PRPH-ca Epic, GE Healthcare, CDC (eMaRC), CareEvolution

Content Creator, Consumer

Pathology (PATH) ARPH CareEvolution, CDC (eMaRC) Report Sender, ReceiverLaboratory (LAB) XD-Lab CareEvolution, Epic Content Consumer

Use Case 7

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Care Theme: Leveraging Healthcare Registries in Care DeliveryUse Case: Optimizing Cancer Care Coordination Leveraging a Central Cancer Registry and Closed-loop Referral MgmtPrimary Goal: To demonstrate clinical cancer information exchange between physicians, pathology labs, and public health cancer registries.

Key Points:• Provide local physician clinical information to a Public Health State Cancer Registry on all patients diagnosed with a reportable cancer. • Exchange clinical information between specialists and PCPs for patients diagnosed with cancer. • The reporting of clinical information from the physician office to the Public Health Cancer Registry will provide additional information

(such as referral to a specialist, treatment, etc.) for patients diagnosed with cancer. • This clinical information will be consolidated with the information received from hospitals and pathology laboratories to create a complete

cancer record for the patient.

MU Relevance: HIT Objective 4- Improving Quality and Population Health, MU1- Submit reportable cancer conditions, MU2- Clinical Quality Measures (CQM) for Breast Cancer Screening (supported by HIE analytic services)

2- HIE receives the Clinical Document Architecture (CDA) standardized reports from Dr. General’s EHR and processes them so they are available for its subscribers.

3- Surgeon performs lumpectomy, and Oncologist determines that a combination of radiation therapy and chemotherapy is appropriate for her Stage IIA cancer. Oncologis prescribes oral Tamoxifen . Cancer Report including the stage information, radiation therapy referral, prescription for Tamoxifen and the administration of chemotherapy

4- Public Health State Cancer Registry receives electronic submission from the Pathology Laboratory, the Surgeon and Oncologist EHR systems. The State Cancer Registry System retrieves the physician cancer reports from the HIE regarding diagnosis, referral, treatment plan and treatment administered. The State Cancer Registry system processes the data, performs validity and consistency checks. The Registry’s Certified Tumor Registrar resolves any identified discrepancies and the final information is stored in the State Cancer Registry System. The State Cancer Registry System submits de-identified data to CDC. CDC receives de-identified data from states and performs statistical analysis from the national perspective. 5- The HIE also Provides Analytic tools supporting Meaningful Use Stage 1 Clinical Quality Measures for Breast Cancer

6- The patient returns to her primary care provider following the referral for further care coordination and incorporation of her updated care needs into her overall care.

Care Theme: Leveraging Healthcare Registries in Care DeliveryUse Case: Optimizing Cancer Care Coordination Leveraging a Central Cancer Registry and Closed-loop Referral Mgmt.

Clinical Workflow:

1- PCP 2- Path Lab/HIE 3- Cancer Center

5- HIE/Quality Measurement Processing

HIE1| HIE2 HIE2| HIE3

4 - Public Health State Cancer Registry

4 - CDC

6- PCP

1- Patient presents to PCP routine annual screening mammogram. shows a very suspicious area of micro calcification. performs a needle guided biopsy and sends the specimen to the laboratory. The pathology report indicates a small focus of infiltrating ductal carcinoma, with ER, PR and HER2 markers positive. PCP meets with the Patient to tell her about the cancer diagnosis. She refers Patricia to a surgeon and an oncologist for treatment. The EHR completes a Cancer Report. Providing it to the HIE for access by care providers and for Public Health Reporting.

Visit the IHE Product Registry at: ihe.net/registry