Illawarra Shoalhaven Cancer and Haematology Network (ISCaHN) has been using an oncology information system (OIS) as a complete electronic record for over 4 years. There has been both considerable and valuable treatment data generated at the point of care. Are we able to rapidly assess the outcomes of our own treatment data, and use this outcome data to help inform the delivery of care to our patients?

2. ISCaHN Treatment Dashboard:
Providing Clinician Decision Support with
Data Generated at the Point of Care
Graeme Bell and Chee Fon Chang

3. Aim
 To describe the development of a treatment dashboard at
Illawarra Shoalhaven Cancer and Haematology Network
(ISCaHN)

4. Treatment Dashboard
 The aim of the dashboard is to present data extracted in
real time from our Oncology Information System (OIS) that
is accessible and actionable for clinicians
 This data can then be used to inform and support treatment
decisions

5. Outline
 Foundation
 Development
 Production

6. Foundation
 Rapid Learning System (RLS)
 Oncology Information System

7. Foundation - RLS
 Etheredge defined a rapid learning health care model as
one that generates as rapidly as possible the evidence
needed to deliver quality patient care 1
 Users learn as much as possible as soon as possible
through the collection of data at the point of care that can
then be used to inform clinical care and service delivery
 Whilst this model has been developed around the concept
of “big data”, it is also possible to apply it at a localised
level to achieve similar outcomes
1. Abernethy et al, 2010

8. RLS

9. Challenges for Big Data and RLS
 Data correctness
 Data completeness
 Data consistency
 Data storage

12. Development
 Dashboard not developed in isolation
 Result of experience from multiple extraction projects
including:
– CINSW Enhanced Medical Oncology Reporting Project
– Oncology Day Care Enhanced Scheduling Project
– Activity Based Funding Extract
– PROMPT care pilot project

13. Development
 From lessons learnt in extract projects we were able to
develop an extract with relevant clinical data
 This data is then displayed in a dashboard for clinicians to
access in a readable and accessible form

15. Intake Data
 You can only pull out what you've put in
 Ensure quality and completeness of data
– Use of manual and automated QA's
– Regular staff training, education and support
 Data needs to be accessible and actionable for clinicians

17. Data Transformation and Aggregation
 Treatment dashboard
 Chemotherapy protocols – different protocols dependent
upon diagnosis, stage, co-morbidities
 Gold standards in curative disease, greater variability in
palliative setting
 Dash board not solely a tool for clinicians, we aim to
develop an option for patient viewing, so that they can be
walked through treatment options, empowering them in
their own treatment decision

18. Production - Treatment Dashboard – Care
Plan Selection

19. Treatment Dashboard – Ipilimumab

20. Treatment Dashboard - Ipilimumab

21. Treatment Dashboard – Toxicities and
Demographics

22. Treatment Dashboard Filter

24. Carboplatin/Gemcitabine in NSCLC
D1 or D8 Carboplatin?
 Carboplatin combined with Gemcitabine has an established
role in the treatment of advanced NSCLC
 In 2009 Crombie et al evaluated Two 21 day gemcitabine-
carboplatin schedules
 Phase II study where 40 patients were given Gemcitabine
on D1 and Day 8 of a 21 day cycle, with patients being
randomized to having Carboplatin on either D1 or D8 of
their treatment
 Results of the study showed that Carboplatin administered
on D8 resulted in lower dose intensity and more dose
delays

25. Carboplatin/Gemcitabine in NSCLC
D1 or D8 Carboplatin?
 Based on the results of the Crombie study, eviQ
superseded their Carbo/Gem (D8 Carbo) protocol in July
2013, and left only the Carbo/Gem (D1 Carbo) protocol
approved
 At ISCaHN, we had also made a similar change in practice
 From January 2011 to March 2013 patients were
prescribed the Carboplatin/Gemcitabine protocol with D8
Carboplatin
 From March 2013 the majority of patients were prescribed
Carboplatin/Gemcitabine, with carboplatin being delivered
on D1

26. Treatment Comparison

27. Demographics
Carbo D1 Carbo D8
Carbo
D1
Carbo
D8
Sex Male % 70 45
Sex Female % 30 55
Stage III % 15 30
Stage IV % 85 70
Crombie et al

28. Results
 Progressive disease on treatment comparison is possible
 Average patients delayed per cycle comparison is possible
Crombie et al ISCaHN
D1 Carbo
n = 20 (%)
D8 Carbo
n = 20 (%)
D1 Carbo
n = 83 (%)
D8 Carbo
n = 97 (%)
7 (35) 8 (40) 33 (40) 38 (39%)
Crombie et al ISCaHN
D1 Carbo
n = 20 (%)
D8 Carbo
n = 20 (%)
D1 Carbo
n = 83 (%)
D8 Carbo
n = 97 (%)
2 (10) 4.75 (24) 23 (27) 40.7 (42)

29. Results
 Toxicity comparison will be possible, still working on bugs
in the report and display of these
 Unable to provide comparison for response rates as this is
currently poorly and/or not uniformly documented in day to
day clinical practice
 Survival rates/time currently not calculated, but will be
possible in future

30. Dashboard Difficulties
 Similar to large scale difficulties
– Incomplete data entry
– Inconsistent data entry
– Incorrect data entry
 Survival outcomes, particularly for positive prognostic early
stage dx (breast, colon etc), requires lengthy time for
measurement of PFS rates and OS rates

31. Conclusion
 Able to extract, aggregate and analyse data generated at
point of care to inform and optimise patient care
 Ability to identify and measure patterns and trends in real
time
 Visualisation of data enables rapid hypothesis generation
 Possible to quickly compare treatment data with that from
published clinical trials

32. Conclusion
 There are holes in the data – requires continued audit and
QA
 Engage with staff, make the data presentable and
actionable, giving a reason for complete and correct data
entry

33. Thanks
 Chee Fon Chang
 Anthony Arnold
 Amy Hains

34. References
Abernethy AP, Etheredge LM, Ganz PA et al. Rapid-Learning System for Cancer Care.
Journal of Clinical Oncology. 2010;28(27): 4268-4274
Crombie C, Burns WI, Karapetis C, Lowenthal RM et al. Randomized phase II trial of
gemcitabine and either day 1 or day 8 carboplatin for advanced non-small-cell lung cancer: Is
thrombocytopenia predictable? Asia-Pacific Journal of Clinical Oncology 2009;5: 24-31