Purpose: To improve access to specialty care for Veterans with a cancer concern and to improve communication among providers.
Background: Providers at the Cleveland VA Medical Center (CVAMC) voiced concerns that the process for Veterans with a cancer concern was fragmented, leading to potential delays in cancer diagnosis. The CVAMC developed an innovative process for the Cancer Fast Track Econsult (CFTE-C) to assist providers with expediting care for Veterans with a cancer concern. This process aims to improve communication between primary and specialty care providers, expedite pre-cancer workups, and allow more meaningful face to face first oncology specialty visits.
Methods: The E-consult is initiated by a primary care provider (PCP) in CPRS. After entering the CFTE-C an oncologist triages the consult to determine workup needed. The care coordinator (CC) ensures implementation of the plan of care and tracks its progression. This is done by the CC entering each Veteran into the Task Tracker (TT), a smart calendar that is used for communication and seamless coordination for selected Veterans. The CC continuously monitors the progression of diagnostic testing to ensure timeliness and identify delays. During the diagnostic process, the CC communicates the process to the PCP in CPRS. After cancer is confirmed or ruled out the CC discusses treatment plan with oncologist, documents in CPRS and notifies PCP.
Results: Since July 2015 there have been a total 145 veterans that have been referred to the CFTE-C. The average time from consultation to first action is 3 days. There is an average of about 6 CFTE-C consults monthly.
Implications: The CFTE-C process of using the TT allows the CC to monitor the Veterans workup and identify delays and barriers to care. The CC assists in eliminating any barriers or delays identified. The CFTE-C is underutilized by PCP’s and efforts are underway to improving utilization
by identifying a PCP champion in the outpatient clinics. There is also a need for clear measures of timeliness of care. Templated notes are in production to allow for clear tracking of the entire process including a clear handoff to PCP or referring provider.
