disclosure belangen spreker (potentiële ......tumor board-report free text. many variations. •...
TRANSCRIPT
(potentiële) belangenverstrengeling Zie hieronder
Voor bijeenkomst mogelijk relevante relaties met bedrijven
Bedrijfsnamen
ZINL, Health Holland, NWO-DATA2PERSON funding for projects related to shared decision making
Member scientific advisory board Evidencio (unpaid)
Member scientific advisory board Pathology Image Exchange (PIE, unpaid)
Member expert council CZ (unpaid)
Evidencio CZ
Disclosure belangen spreker
Decision support in Oncology - Oncoguide
Xander Verbeek, IKNL
• 1990-1996 Applied Physics
• 1996-2004 PhD/Post Doc CARIM
• 2004-2014 Philips Health Informatics
• 2004-2006 Health Information Management
• 2014-today IKNL Chief Innovation Officer, Head of Health Informatics
& Data Science
Xander Verbeek
IKNL
Netherlands
Cancer
Registry
Registration
Analysis
3. Application
Patient
data
Population Based
Registy
Knowledge
Actionable
Insight
1
2
3
4. Standardization
4
OncolinQ innovation program – technology innovations
Rapid
Learning
Healthcare
System
Registration
Analysis
3. Application
Patient
data
Population Based
Registy
Knowledge
Actionable
Insight
1
2
3 Decision support,
data & knowledge services
Privacy preserving
distributed machine learning
Secure electronic data
exchange & access
Standardization,
FAIR principles
Field research
Scope: Clinical information management and decision making
Near exponential growth scientific publications
Breast Cancer Prostate Cancer
Lung Cancer Colorectal Cancer
Netherlands Cancer Registry
2018: 2,3 miljoen 2018: 2,3 miljoen
Number of patients in NCR
+250 publications/year
Towards a rapid learning healthcare system
010100101001010
010101010101010
101010111010100
010100100101110
100101011010011
001101010101101
101011110001101
010100110101001
010110001010101
011001010100111
101010101010111
Guideline driven Data driven
From guidelines to algorithms and data driven decision support
From guidelines to algorithms and data driven decision support
CT scan
MRI Decision
Echo +
biopsy
Care
pathway
Initial diagnostics Initial treatment
Decision
Chemotherapy
+ CT scan
Surgery +
pathology
Decision
Chemotherapy
Radiotherapy
Re-operation
Post-operative treatment
Preg-
nant
Age
CT scan
MRI
>=50j
<50j
nee
ja
… Echo +
biopsy
cT
<cT1
>=cT2 G
Chemotherapy
+ CT scan
Surgery +
pathology >G1
pT
pT1 Chemotherapy
Radiotherapy
G
pT2
>=pT3 >=G2
G1
R
Re-operation
Free
Not free
Data driven
decision
algorithms
<= G1
Tumor
Board
Tumor
Board
Method based on insights from decades of research on computer interpretable guidelines
Recommendations
Clinical Decision Trees
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
“It captures the
essence of the
guideline” Physicians @ NCCN
conference 2018
Example: postoperative radiotherapy breast cancer
Clinical Decision Trees
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
Nodes
Patient/disease
characteristics
(e.g. Surgical Margin)
Nodes
Patient/disease
characteristics
(e.g. Surgical Margin) Branches
Cut-off values
(e.g. Free)
Branches
Cut-off values
(e.g. Free)
Leaves
Recommendation
(e.g. Radiotherapy)
Leaves
Recommendation
(e.g. Radiotherapy)
Data item:
Surgical margin (SNOMED CT 82868003)
Value set:
-Free (SNOMED CT 55182004)
-Focal not free (SNOMED CT 370109009)
-More than focal not free (code requested)
Source:
PALGA PROTOCOL excision specimen
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
Standardization as prerequisite for connecting to EHR
Rigorous application of
appriopriate international
classification and coding
systems
Rigorous application of
appriopriate international
classification and coding
systems
PICO
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
Standardization as prerequisite for connecting to EHR
Standardized
Standardization – linguistic unity
Pathology report • Free
• Focal not free
• More than focal not free
Registries • Radical or absent and DCIS radical or absent
• Radical or absent and DCIS focal not radical
• Radical or absent and DCIS not radical
• Focal not radical and DCIS radical or absent
• Focal not radical and DCIS focal not radical
• Focal not radical and DCIS not radical
• Not radical and insignificant
• Margin invasive and/or DCIS component not clearly
stated
Guideline • Tumor free margin
• Focal extension
• More then focal extension
• Radical/not radical
• Margin involvement
• Tumor free resection
• Irradicality
• Free resection margins
• Focal tumor positive
margin
• Extensive tumor positive
margins
Tumor Board-report Free text. Many
variations.
Information standard: • Free
• Focal nor free
• More than focal not free
Surgical tumor margin
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
Results Breast Cancer
376 subpopulations
199 pages free text 60 decision trees 114 data-items • 49% pathology
• 27% radiology
• 24% clinical
• 66 ~ TNM
• 8 ~ BIRADS
• 90 ~ SNOMED
Oncoline Art-DECOR Oncoguide
+ +
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
guideline algorithms information standard
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
RESTful API
EHR connector
Implementation pilots
Submitted to JCO
Impact on quality of documentation and workload of the introduction of a
national information standard for breast cancer tumor board reporting
Kees C.W.J. Ebben1, Melle Sieswerda1, Ernest Luiten2, Joan Heijns3, Carmen van der Pol4, Maud Bessems5,6, Aafke
Honkoop7,6, Mathijs Hendriks8, Xander A.A.M. Verbeek1
Clinical evaluation study Amphia Hospital
Oncoguide Advisor
OG Guideline Surgery, mastectomy
OG Trial NEXUS-II
OG Predict 5-y survival Neoadjuvant chemotherapy 12-34%
5-y survival Surgery 14-41%
Patient: Isabella Strong, (01-12-1973) Tumor Board (pre-op)
Diagnosis Breast cancer
TNM cT3a cN1 cM0
Morphology/Grade Tubuloductal G3
Receptor ER+ PR- HER2+
RECOMMENDATION Neoadjuvant chemotherapy
OncolinQ innovation program
PALGA standardized pathology report
Patient: I. Strong, (01-12-1973)
Diagnosis Breast cancer
Morphology Tubuloductal G3
Receptor ER+ PR- HER2+
IIA
Electronic Health Record (EHR) standardized reporting Oncoguide
Knowledge sources
Patient: #3%3416AA, (01-12-1973)
Diagnosis Breast cancer
TNM cT3a cN1 cM0
Morphology Tubuloductal G3
Receptor ER+ PR- HER2+
Registries
NKR ↓
Integrating Real World Data
NKR ↓
Integrating Real World Data
NKR ↓
2013
2014
2015
2016
Integrating Real World Data
NKR ↓
17449
18330
14507
124
3813
97% 86%
2391
7774
48%
1834 185
372
284
212
64% 67% 60% 75%
881
Integrating Real World Data
Integrating Prediction Models
•New prediction models
•Validation international models
IBM Watson versus Oncoguide
Other developments
Beyond Breast Cancer Beyond Oncology Beyond the Netherlands
“If medicine wishes to stay in control of its own future, physicians will not
only have to embrace algorithms, they will also have to excel at developing
them, bringing machine learning methods into the medical domain”
www.iknl.nl
www.linkedin.com/company/iknl
twitter.com/iknl
1 2
Registration Analysis
3
Application
From guidelines to algorithms and data driven decision support
CT scan
MRI Decision
Echo +
biopsy
Care
pathway
Initial diagnostics Initial treatment
Decision
Chemotherapy
+ CT scan
Surgery +
pathology
Decision
Chemotherapy
Radiotherapy
Re-operation
Post-operative treatment
Preg-
nant
Age
CT scan
MRI
>=50j
<50j
nee
ja
… Echo +
biopsy
cT
<cT1
>=cT2 G
Chemotherapy
+ CT scan
Surgery +
pathology >G1
pT
pT1 Chemotherapy
Radiotherapy
G
pT2
>=pT3 >=G2
G1
R
Re-operation
Free
Not free
Data driven
decision
algorithm
<= G1
Tumor
Board
Tumor
Board
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
Based on insights from decades of research in health informatics
Data
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
M. Hendriks, X. Verbeek, T. Vegchel, M. vd Sangen, L. Strobbe, J. Merkus, H. Zonderland, C. Smorenburg, A. Jager, S. Siesling (In Press JCO-CCI)
Integrating Prediction Models
NABON workgroup EHR standardization