Since July 2011, Luton and Dunstable University Hospital NHS Foundation Trust Cancer Services have used the InfoFlex Patient Tracking system to successfully manage their mandatory cancer data reporting. The reporting covers COSD (Cancer Outcome and Services Dataset) and CWT (Cancer Waiting Times), as well as a range of other monthly, quarterly and annual reports such as NPCA (National Prostate Cancer Audit), NLCA (National Lung Cancer Audit), NBOCAP (National Bowel Cancer Audit) and NOGCA (National Oesophageal Cancer Audit).
- Reliable monitoring of every stage along the cancer pathway
- Alert processes reduce the risk of delays to treatment or procedures
- Clearly signposted pathways and targets drive clinical excellence
- Latest information is available for access by all clinicians/support staff
- Effective patient tracking system supports meeting of mandatory reporting targets
- Provider’s expertise with interfacing supports implementation of other clinical systems
- Knowledgeable and experienced provider team supports design, implementation and running of complex system
- Dedicated on-site, front-end management and system administration support ensures effective system performance
“For reporting newly introduced CWT targets and data, our Microsoft Access databases were not sophisticated enough. We needed something clever so we had to find a solution.”
Eileen Fox, InfoFlex Development Manager
Before 2011, Access databases were used for patient tracking across all tumour sites. However, when major changes to the Cancer Waiting Time standards were introduced, as well as the establishment of COSD reporting in January 2012, the existing system was found to be inadequate. An alternative was needed to manage, manipulate and report on the complex data required.
Furthermore, Cancer Services were dealing with greater and greater volumes of referrals: at present about 1800 referrals are managed by the system every month, of which 750-800 are 2WW referrals, the remainder being national screening, urgent and routine referrals.
Design and Implementation
Eileen researched possible solutions and chose InfoFlex: “I looked around and reviewed what was in use in other hospitals and chose InfoFlex. It does the job.”
As the provider, the InfoFlex team also offered knowledge and understanding of the challenges faced by Cancer Services. Eileen explained: “Their understanding of how trusts work, plus the knowledge of CWT rules and regulations, were exactly what we needed and helped enormously at the front end when we were trying to build something from new.”
Two main interfaces were set up, firstly with the iPM PAS from which comes a live demographic feed, so that every patient coming onto the hospital system is registered in InfoFlex , whether a cancer patient or not.
The second interface is a 12 hourly feed for referrals. The InfoFlex interface process identifies, from the referral content, which of those referrals are potential cancer cases, that is they are either referrals for 2WW or National Screening or with a cancer code. A relevant pathway is set up from which worklists are created. Eileen commented: “Worklists in InfoFlex are the bibles for the Cancer Services administration team. They are used to track the patients every day.” Referrals tip into the worklists every day and worklists are also refreshed every day. Colour coding allows the administration team to keep track of where the patient is on their individual pathway, warning of potential breaches in a highly visual way.
As for MDTs from which COSD data is extracted, the development team set up a data view in InfoFlex for every tumour site separately (now standing at 12 separate sites). Learning from experience that very individualised, complex designs were difficult to manage given resourcing and time issues, Eileen decided to prioritise the mandatory and required reporting items. Also, by choosing generic terms, subsequent changes to the National Dataset would be relatively less complicated to achieve.
To collect clinical MDT data against targets, proformas were designed for each tumour site. In addition, separate proformas had to be designed for different patient groups within each specialty, such as new referrals, post-operative or one-stop clinic patients.
An administrative team of 15 use these proformas during MDTs to collect data which is subsequently entered onto the InfoFlex system, as both free text and drop down items. Helen Watt, Business Manager, Cancer Services, commented on the challenge of dealing with the increasing number of patients that have to be discussed within a limited time frame. For example, 60 breast cancer patients are discussed within a 3 hour time frame when it used to be 20.
Support with the proforma design came from the InfoFlex implementer. “Louise Buxton, InfoFlex Account Manager for the Trust, would come up with a solution. She understood what we needed to achieve, where we needed to get to. Without that you could so easily make a rod for your own back and build it the wrong way.” Subsequently, InfoFlex support has been available when changes have been made to the national datasets. Information Standards Notices of altered datasets are sent to the InfoFlex team where they are implemented into the InfoFlex Cancer system and released back to the customer base.
However, if the trust wants to make small additions to the pathway to support local data collection, such as a small data field or tick box, these can be built in easily – another advantage of the InfoFlex toolset. Eileen commented: “We like the InfoFlex Patient Tracking System, it does exactly what we need and if we want to add something we can build things in as we need them.”
Such is the success of the Luton and Dunstable Cancer Services’ reporting and patient tracking that they have become a regular reference site for other trusts investigating effective cancer patient tracking systems