What is the new Cervical Screening Program what

What is the new Cervical Screening Program & what does it mean for your Recall & Reminder System? Katrina Otto, Train IT Medical www. trainitmedical. com. au katrina@trainitmedical. com. au

Learning Objectives: 1. Explain the changes to the National Cervical Screening Program beginning 1/12/17 2. Apply the new cervical screening guidelines to your practice’s recall and reminder processes. 3. Improve understanding and monitoring of cancer screening rates using Pen software.

Learning Objective 1: Explain the changes to the National Cervical Screening Program starting 1/12/17

New screening guidelines CURRENT PAP TEST SCREENING Pap Test every 2 years Current screening age: 18 -69 years NEW CERVICAL SCREENING TEST (CST) Starting 1 December CST Test every 5 years CST screening age: 25 -74 years

What else is new? Ø New National Cancer Screening Register (NCSR) is due 2018. Women will be invited by the NCSR to participate in screening. Ø Women aged 70 to 74 years will be invited to have an ‘exit test’ Ø Option for self-collected sample.

Self collection “For your patients that may have refused to screen, an alternate method of collection is available but patients must meet the eligibility criteria; be over 30 years of age and be overdue for their screening test by two years or more. ” Dept of Health, National Cervical Screening Program Self-Collection Quick Reference Guide

Why are we changing the test? 1. LIMITATIONS of CURRENT TESTING Reductions in cervical cancer incidence and mortality have plateaued over the last 10 years Current program has had no impact on certain groups – women < 25 years, subgroups of cancers (adenocarcinomas) Clinical slides available from: http: //ncphn. org. au/wcsc/cervical-screeningworkshop-presenter-slides/ Credit to Dr Jo Adendorff, Dr Brenda Rattray and Dr Renee Strazarri

We have a BETTER TEST

Why are we changing the test? “ 99. 7% of cancers of the cervix are the result of persisting HPV infection. Rather than looking at abnormal changes in the cells we’re taking it one step back and looking at HPV infection. ”

Why are we changing the test? Hear Dr Sweeney explain the changes https: //www. youtube. com/watch? v=f. Eb. VEyi. KUi. Y

Why are we changing the test? 2. INCREASED KNOWLEDGE The role of HPV in cervical lesions and cancer (causes >99% of cancer, most HPV infections will regress within 18 months) Pathogenesis of cervical cancer (most cancers take 10 -15 years to develop)

Let’s eradicate cervical cancer!

What is changing in our software?

Request NB. Early preview – subject to change

Patient Record View NB. Early preview – subject to change

What is changing in our software?

The Request form Default test will be “CST Routine” Interface available from 1 st December NB. Early preview – subject to change

Patient record view References to Pap Test or Pap Smear have been renamed as Cervical Screening or Result, depending on context of the area adjusted. NB. Early preview – subject to change NB

What’s not changing? We still need well managed practice recall and reminder systems

Learning Objective 2: Apply the new cervical screening guidelines to your practice’s recall and reminder processes.

General Practice Standards RACGP 5 th Standards Criterion C 4. 1 - Health promotion and preventive care “Some information may also be transferred to national state-based registers (eg. cervical screening etc) Remind patients when they need to have another screening (do not rely on patients receiving reminders from these registers). ” Read RACGP 5 th standards

Actions, Recalls and Reminders REMINDERS eg. routine Cancer Screening Test (CST), immunisation, breast check RECALLS (ie clinically significant/medico-legal) eg Colposcopy For ‘reminders’ that are only for the clinician, consider: ‘ACTIONS’ eg. Discuss screening, discuss smoking

Let’s discuss transition strategies: Women who: - are aged 25+ years will be invited into the new program 2 years after their last Pap test - have had a Pap test below the age of 25 will be invited into the program at the routine screening age of 25 (explanatory letter to be sent by National Register)

Systematic preventive health management Practices need: • • • Clear system Goals/Plan Defined roles Communication Training

Results (Inbox/Holding File Follow-up) ‘System’ Pathology Results Radiology Results Specialist Letters Discharge Summaries Scanned documents

Entering result Inclusion of new risk categories: - Low Risk - Intermediate Risk - Higher Risk - Unsatisfactory NB. The previous risk categories remain on this list to provide facility for Clinicians to record current and historical results. NB. Early preview – subject to change

CREATE YOUR OWN An effective ‘Holding File’ system is vital See samples: http: //trainitmedical. com. au/manuals-free-downloads/md-ps-free-templates

CREATE YOUR OWN An effective ‘Inbox’ practice system is vital Download a blank flowchart here: http: //trainitmedical. com. au/manuals-free-downloads/bp-software-resources-free-templates

SAMPLE ONLY An effective practice system is vital Download a blank flowchart here: http: //trainitmedical. com. au/manuals-free-downloads/bp-software-resources-free-template

New Recall/Reminder labels required NB. Early preview – subject to change

We’ve seen what can happen if we’re not careful: Tips for Success: § Define your system § Control your list § Label so patients don’t stress if they receive a sms or letter with the reason.

Now’s a great time to start data cleansing!

Save time, money AND minimize risk With a list like this how do you identify true recalls ie. Clinically significant/probability of harm/must follow-up/medico-legal/keep the doctor informed & document every single contact attempt?

SAMPLE ONLY

Coming soon in Bp Premier • SMS reminders • Patient app – ‘Best Health’ Download Train IT Medical ‘Results Management’ Presentation from Bp Summit 2017

SAMPLE ONLY

Follow Up Recalls & Reminders • Track Contact Attempts • Review Audit Log • Remove recall once complete

Learning Objective 3: Improve understanding and monitoring of cancer screening rates using Pen software.

CAT Plus Suite of Tools PAT CAT CAT 4 Top Bar These tools work at all 3 levels to improve data capture at point of care, analyse data at practice level and aggregate data for service planning at a population level.

Clinical & financial incentives to improve Accreditation Changes: - linked to data 5 th Standards just released! Practice Incentive Payment (PIP) changes: - linked to data PIP Redesign FAQs Webinar recording

A planned, systematic approach Identify at risk groups/patients Flag for follow up / recall Screen/test or refer patient Review result & ‘action’ Recall patient as necessary

“If you can’t measure it, you can’t improve it” Peter Drucker

Use CAT 4 to analyse your data 3 steps 1. Collect an Extract 2. Apply filters 3. Analyse the Extract Download cheatsheet www. pencs. com. au

Step 1. CAT 4 – Collect an Extract

Step 2 CAT 4 – Apply Filters

Step 3. CAT 4 – Analyse the Extract

HPV immunisation - adolescents Let’s get passionate about HPV immunisation – again!

NATIONAL HPV VACCINATION PROGRAM 3 dose quadrivalent vaccination (Gardasil): HPV 6, 11, 16, 18 2007 – girls (12 -26 yrs), 2013 – girls and boys (12 -13 years) Coverage with 3 doses: around 70 -80% 86% reduction in HPV 16, 18, 6, 11 92% reduction in genital warts 45% reduction in low grade lesions 85% reduction in high grade lesions

Screening and Prevention Identify all eligible patients NOT screened for FOBT, Mammograms etc Read my blog on Data Aggregation using Pen Clinical Audit Tools Download summary sheets on how to enter screening data in your clinical software

New ‘Cervical Screening’ filter coming soon!

Export to a spreadsheet (or set prompts for topbar)

Use topbar for proactive reminders

Customise your own topbar prompts ü Prompts are set up in CAT 4 or PAT CAT ü Activate when patient file is opened ü Customisable by practice

CAT Plus prompts - example

Recipes – Maximise Business Potential http: //help. pencs. com. au/

Design a Practice Improvement System Design a practice system for data analysis and reporting improvements • Identify key areas you want to improve eg. Improve screening, set realistic specific goals • Baseline current level of recording • Implement improvements (ie staff training, regular audits etc) • Measure regularly (monthly) to track progress over time • Review regularly to ensure ongoing improvements

Set your KPIs eg increase screening visits Tips: Encourage a team effort to achieve the goals by setting a target on the graph & place graph in the staff room/noticeboard to encourage a proactive approach.

Session 2: Effective Recall & Reminder systems – putting ideas into action Katrina Otto, Train IT Medical www. trainitmedical. com. au katrina@trainitmedical. com. au

Learning Objectives: 1. Identify a range of approaches for achieving improved financial and patient outcomes through efficient recall and reminder systems 2. Have identified actions to introduce at their own practice 3. Better understand the benefits of effective recall and reminder systems 4. Has the opportunity to productively network and share with the staff of other practices

Why improve our screening? According to the National Cervical Screening Program Report (2014 -2015): - Around 6 in 10 women participate in the National Cervical Screening Program. - There is a clear association between participation and socioeconomic group (from 51% for those in the lowest socioeconomic group to 63% for those in the highest) https: //www. cesphn. org. au/news/latest-updates/57 -enews/2516 -increasing-access-to-cervical-screening-for-under-screened-and-never-screened-women

Why improve our screening? Indigenous women have lower screening rates and poorer outcomes. Incidence of cervical cancer in Aboriginal and Torres Strait Islander women is more than twice that of non-Indigenous women, and mortality is four times the non-Indigenous rate Let’s work together to close the gap. https: //www. cesphn. org. au/news/latest-updates/57 -enews/2516 -increasing-access-to-cervical-screening-for-under-screened-and-never-screened-women

Success story – Erin Shannon Five Star Medical, Port Macquarie

Success story – AB Surgery Kempsey

Success story – Sonia Perry Trial Bay Family Practice

Success story – Vicki Coombes Star Street Macksville

Under screened or never screened

Table talk Why might women be ‘under screened or never screened’? How might we improve our practice environment for cervical screening?

Table talk What’s a burning issue for your practice? Identify 1 improvement

Katrina’s ideas • Plan a patient education strategy to inform and engage your patients re Cancer Screening Test (CST)? • Re-evalute your ‘systematic’ approach to reminders. • Plan a proactive approach for first CST at age 25 years. • Generate an income estimator for a planned preventive health approach to recall these patients • Engage your team. Brainstorm eg. why patients may be underscreened (or not screened) & how to improve • Engage (eg survey) your patients to identify challenges/improvements • Plan your improvement (one step at a time)

Katrina’s top 7 tips for Success 1. 2. 3. 4. 5. 6. 7. Set small (achievable) ‘data’ goals Review & document key processes Train all Staff on software & new processes Focus on key data items Create a team spirit Monitor and communicate performance Celebrate progress – no matter how small

Further Information Train IT Medical Free Resources – Cervical Screening Program National Cervical Screening Program - Dept of Health - FAQs Cervical Screening Changes FAQ - Video - Dr Sally Sweeney Hunter New England Central Coast PHN (HNECCPHN) NPS Information & FAQs NPS free e. Learning Cancer Council Australia Cancer Guidelines Wiki 'Cancer Council study confirms starting cervical cancer screening at age 25 is safe' Cancer Institute NSW 'Information for Health Professionals' Untold Stories - Cervical Cancer Screening - Audio-visual stories (Family Planning NSW). Spoken in Arabic, Assyrian, Dari, French, Hindi, Karen, Khmer, Mandarin, Nepalese & Vietnamese. 'Changes to cervical screening will benefit Australian women' RACGP media release NCPHN Cervical Screening Workshop Presenter Slides

Further Information • RACGP – Putting Prevention into Practice (Green Book) http: //www. racgp. org. au/your-practice/guidelines/greenbook/ • Coding https: //www. digitalhealth. gov. au/get-started-with-digital-health/what-is-digital-health/importance-of-data-quality • Medical. Director – Recalls, Reminders, Actions Fact Sheet http: //medicaldirector. com/uploads/Recalls, _Reminders, _Actions, _and_Outstanding_Requests_Fact_Sheet. pdf • Medical. Director – Recalls, Reminders, Actions Fact Sheet http: //trainitmedical. com. au/wp-content/uploads/2012/07/MDRecommendations_for_SMS_Messaging_with_Appointments_Recalls_and_Reminders. pdf • AMA- Recall systems and patient consent - https: //ama. com. au/position-statement/patientfollow-recall-and-reminder-systems-2013 • Avant – The Dos and Don’ts of patient sms http: //www. avant. org. au/news/20160419 -dos-anddonts-of-patient-sms-communication/ • Train IT Medical – Practice Management free resources – http: //trainitmedical. com. au/practice-management-free-resources •

Thanks to everyone attending today, to thanks to NCPHN, Medical. Director & Best Practice Software + Pen Clinical Systems katrina@trainitmedical. com. au. Twitter: trainitmedical Facebook: trainitmedical www. trainitmedical. com. au Access more free practice resources & blog posts Subscribe to my blog With best wishes, Katrina Otto