Transformational change for women with breast cancerLaura Esserman, MD MBATerri Spencer, Sr. Manager Development & Engineering, CSM,CSPO, SAPMSeptember 2012

Breast Cancer

200,000 diagnoses

45,000 deathsAnnually

We are working toward personalized treatment

If breast cancer comes back(usually not curable)

Genetic testing on tumor cells

We also need to tailor screening and prevention

Risk

Benefit of early detection

“Cost” of unnecessary

screening

On a Mission to Achieve Transformational Change

A collaboration across 5 University of California medical centers• 150,000 women being screened for breast cancer

• 10,000 women diagnosed

Data in, Knowledge out

Capture patient stories and preferences, tumor biology, clinical performance

To deliver, personalized prevention, screening, and treatment

To deliver better care tomorrow by enabling care to be an engine for discovery and improvement

Breast cancer screening today:

Screening the Athena way…

• Single schedule for mammograms,

clinical breast exams

Today’s Standards

8

Annual screeningWomen

Ages 40-90Screen every 6

mo. or prophylactic

surgery

Most women

BRCA 1/2 +women

Women Ages 40-90

At risk for IDLE/VERY low

tumorsLifestyle

interventions

At risk for HR+ tumors

Lifestyle interventions,

endocrine therapy

More frequent screening

Interventions to change host environment

PARP inhibitors, surgical

prophylaxis, endocrine therapy

PreventionImage Screening

MammogramQuantitative breast

density

HealthQuestionnaire

Lifestyle factorsFamily history

BloodiCOG chip GWAS

Myeloid profile

Personalized risk profile

Initial screen

Less frequent screening

At risk for TN/Her2 More frequent screening

Interventions to change host environment

Less frequent screening

More frequent screening

BRCA 1/2 mutations

This is what Athena could enable!

New / Updated Risk Models

Envision A Different Future

Athena Risk Calculator

USPSTFNCCN

GailClaus BRCAPro

Feeds into

MammogramTriggersSchedules Athena Health

Questionnaire

Completedat home or in clinic

Creates

If at elevated risk

Woman’s doctor

Athena Participant

Athena Central Registry

Blood or Saliva Collected

Provides Consent for Research

Personalized Risk Report

UsesReferred to

Lifestyle changes(weight loss, alcohol reduction)

Genetic counseling

Clinical Interventions

If at elevated risk

Athena Breast Health

Specialist

Consultation and Referrals

Breast Health Decisions.org

Athena Software Development Process – High Level

Project Mgmt, Agile Frameworks, Release Planning

Athena Risk Calculator

USPSTF

NCCN

GailClaus BRCAPro

Feeds into

MammogramTriggersSchedules Athena Health

Questionnaire

Completedat home or in clinic

Creates

If at elevated risk

Woman’s doctor

Athena Participant

Athena Central Registry

Blood or Saliva Collected

Provides Consent for Research

Radiology scheduling systems Health Questionnaire System (Salesforce)

Mobile App

Web Services

Electronic Medical Record

Database

UsesReferred to

Lifestyle changes(weight loss, alcohol reduction)

Genetic counseling

Clinical Interventions

If at elevated risk

Athena Breast Health

Specialist

Consultation and Referrals

Breast Health Decisions.org

All tracked in the CRM(Salesforce)

Web Service

Help the patient understand her risk

BreastHealthDecisions.org

Help clinicians understand risk and tailor care

Risk Report for Radiologists and Breast Health Specialists

Athena dashboardfor population care

Hired

LeadingAthenaIT team

TS

Athena Data Integration Getting data in and out is always an adventure with Healthcare Information Systems Partnerships and Collaboration

• SalesForce Architect & Athena Development and Engineering Team

• UCSF Medical Center IT and Clinical Applications Team

• Business Subject Matter Experts (SME’s)

Approach• Integrate multiple teams to establish a common data sharing platform

• Implement a prototype – 2 months

Security• Standard HIPAA required Business Associate Agreement (BAA) between

SalesForce and UCSF

Patient Reported Data

Athena Data Integration Strategy with SalesForce

MIRTH Interface Engine Clover Leaf Interface Engine

HL7

HL7

Risk Assessment Data & Report

MSH|^~\&|HQS v1.2|Salesforce|RECEIVING APP|RECEIVING |PID|||E88^^^^EPI||Jane Doe testerJ||1xxxxxxxxx|F|||||||||||282643382||||||PV1||I|EMH UC^UC12^UC12||||2000^^^^^^^^EPIC^^^^PROVID AMBULATORY^PHYSICIAN^^^^^^EPIC^^^^^^PROVID||^^TEST200706121502|TEST200706121501|445654|||Date of Consultation: 3/21/2012 8:38 AM~Breast Health Specialist: BHS_First :

SOAP

My Chart

BRCAGAIL

CLAUS

Record Type

VPN Tunnel

Risk Models

Web Services HL7(text)

Web Services

HL7(text)

Athena Data Integration Strategy with SalesForce

http

Athena Data Integration – Everywhere

Athena Data Integration - Considerations Challenges

• Creating and Implementing processes and procedures

• Defining clear handshakes and ownership of data integration process

• Service Level Agreements (SLA) across platforms

Key Success Factors• Committed stakeholders and cross-functional teams

• Priorities established and approved by stakeholders

• Well-defined architecture, data elements and nomenclature

Vision• SalesForce and data integration to any EMR system

– Test Base - Multiple data integrations for all UC’s (UCSF, UC Irvine,

UC San Diego, UCLA and UC Davis and more….)

Long Term – Forcing data exchange standards in Healthcare IT

Personalized Medicine Revolves Around Data

What to collect

How to collect it

How to share it

Who to share it with

How to transform to knowledge

Data Integrat ion

Our future depends upon our ability to re-engineer our processes and collaborate

Center for Clinical Innovation

Personalized Prevention, Screening, Treatment, Survivorship

Deliver better today

Listen, discover, learn, improve

Deliver even better tomorrow