1. Transformational change for women
with breast cancer
Laura Esserman, MD MBA
Terri Spencer, Sr. Manager Development & Engineering, CSM,
CSPO, SAPM
September 2012

2. Breast Cancer
200,000 diagnoses
45,000 deaths
Annually

3. We are working toward personalized treatment
If breast cancer comes back
(usually not curable)
Genetic testing on tumor cells

4. We also need to tailor screening and prevention
Risk
Benefit of early
detection
“Cost” of
unnecessary
screening

5. 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

6. 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

7. Breast cancer screening today:
Screening the Athena way…
• Single schedule for mammograms,
clinical breast exams

8. Today’s Standards
8
Annual
screeningWomen
Ages 40-90
Screen every 6
mo. or
prophylactic
surgery
Most women
BRCA 1/2 +
women

9. Women
Ages 40-90
At risk for
IDLE/VERY low
tumors
Lifestyle
interventions
At risk for HR+
tumors
Lifestyle
interventions,
endocrine therapy
More frequent
screening
Interventions to
change host
environment
PARP inhibitors,
surgical
prophylaxis,
endocrine therapy
Prevention
Image
Screening
Mammogram
Quantitative breast
density
Health
Questionnaire
Lifestyle factors
Family history
Blood
iCOG 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

10. Athena Risk Calculator
USPSTF
NCCN
Gail
Claus BRCAPro
Feeds into
Mammogram
TriggersSchedules Athena Health
Questionnaire
Completed
at 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

11. 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

12. Athena Software Development Process – High Level
Project Mgmt, Agile Frameworks, Release Planning

13. Athena Risk Calculator
USPSTF
NCCN
Gail
Claus BRCAPro
Feeds into
Mammogram
TriggersSchedules Athena Health
Questionnaire
Completed
at 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

14. 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

15. Help the patient understand her risk
BreastHealthDecisions.org

16. Help clinicians understand
risk and tailor care
Risk Report for Radiologists and
Breast Health Specialists

17. Athena dashboard
for population care

18. Hired
Leading
Athena
IT team
TS

19. 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

20. Patient Reported Data
Athena Data Integration Strategy with SalesForce

21. 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|||||||||||2
82643382||||||
PV1||I|EMH
UC^UC12^UC12||||2000^^^^
^^^^EPIC^^^^PROVID
AMBULATORY^PHYSICIAN
^^^^^^EPIC^^^^^^PROVID||^
^TEST200706121502|TEST
200706121501|445654|||Dat
e of Consultation: 3/21/2012
8:38 AM~Breast Health
Specialist: BHS_First :
SOAP
My Chart
BRCA
GAIL
CLAUS
Record Type
VPN Tunnel
Risk Models
Web Services
HL7
(text)
Web Services
HL7
(text)
Athena Data Integration Strategy with SalesForce
http

22. Athena Data Integration – Everywhere

23. 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

24. 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
Integration
Our future depends upon our ability to re-engineer
our processes and collaborate

25. Center for Clinical Innovation

26. Personalized Prevention, Screening,
Treatment, Survivorship
Deliver better today
Listen, discover, learn, improve
Deliver even better tomorrow