CarePaths Requirements

Objectives and Requirements:

1. enhancement of the current eForm emporium to include:
• storage of care paths or care maps as single page images with their associated html pages
• addition of labels to categorize all eForms in emporium with a specific global label called $carepaths
• eForms with the label $carepaths will be included in the drop down selection when an EMR displays all the available care maps for the MyDrugRef user and his/her trusted friends
2. addition of User Interface to facilitate requirement 1
   
3. $carepaths eForm requirements
   
• the image + html will conform to the current OSCAR v10.12 eForm specifications
• nodes within care map may contain pointers to other eForm contained in the eForm emporium
• when a user picks a node on care map the choice plus any additional comments can be saved to the EMR for future use
• action items which include further diagnostic testing or recommendation for treatment should lead to other eForm to facilitate the action (e.g. a MRI requisition form)
4. updating the MyDrugRef Users Guide to include carepaths

 Deliverable and testing

1. convert the 12 available guidelines for Diagnostic Imaging for Cancer Care to eForms
• $carepaths for Breast CA (4 eForms)
• $carepaths for Lung CA (6 eForms)
• $carepaths for suspected Colon CA (1 eForm)
• $carepaths for Management of Prostate Cancer
  
2. create a MyDrugRef user called JCC
3. add these eForms to the eForm emporium
4. Dr. Chan will add JCC as trusted friend
5. the rest of testing will be done by Dr. Chan using OSCAR as the EMR interface
   

Corresponding feature addition to OSCAR to demonstrate the use of CarePaths

When an OSCAR user with a MyDrugRef Id opens a patient chart

1. a call to MyDrugRef with the OSCAR user's MyDrugRef ID will retrieve all $carepaths for the MyDrugRef user and his/her trusted friends
   
2. if the search result is not null then a CarePaths drop down will appear next to the Calculator tool
• the drop down will list all available $carepaths with sufficient information to help with selection, e.g. title, source/MyDrugRef ID of creator/last revision date
3. once a $carepaths is selected, the eForm ID is compared with what is already available in the local EMR eForm library
• if it is a new eForm then download the eForm from MyDrugRef, decompress it, and open it with eForm tool
4. if a node on the $carepaths is selected then the eForm is automatically saved to document the state of the care path process
5. if the node contains a link to another eForm then check if eForm is already available in local eForm library
• if not available then download from MyDrugRef, decompress it, and open it with eForm tool

Deliverable and testing

1. Dr. Chan opens a patient chart in OSCAR
2. Dr. Chan finds the available CarePaths drop down appearing next to the calculator tool
3. Dr. Chan selects one of the $carepaths and select one of the nodes
4. Dr. Chan follow the carepaths selection until he makes a requisition to order a diagnostic imaging test
5. Dr. Chan removes JCC as his trusted friend
6. CarePaths drop down disappears next time he logs on and opens up a patient's chart
   

Future enhancements (beyond the scope of current pilot testing)

• possibility of geomapping OSCAR user's location to automatically select the appropriate action related eForm tools
• electronic referral from each node
• information items containing precision of test, prognosis, or benefits vs harms of each action item to facilitate discussion between provider and patient
• secure messaging tool to post question to specialists (e.g. oncologist)
• using another EMR to test this platform
• using the MyDrugRef Decision Support tool to automatically screen patients for cancer, e.g. if a smoker over age 40 - recommend $carepaths screening for lung CA
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