Journal of Healthcare Management - May/June 2014 - (Page 179)

a ssess I ng tH e f eas I bI lIty regardless of whether the provider or patient is affiliated with UNC Health Care. A key difference between the VTB and the tumor board requirement of the CoC is that the CoC requires a review of new cases and discussion by the treating providers about the optimal delivery of care, while the VTB provides a second opinion on a limited number of the most complex cases from multiple facilities. Our evaluation details the structure and processes of the UNC VTB, barriers to participation, and perceived value for both UNC and communitybased clinicians. We highlight implications and recommendations for leaders of institutions currently administering or considering implementing a VTB program. METHODS We used an embedded case study design (Yin, 2009), with the UNC VTB as the overarching case, composed of multiple tumor boards, each with individual clinician participants. Our primary unit of analysis was the individual participant, and our focus was to explore participants' experiences with the VTB. The study, funded by the state-supported University Cancer Research Fund, was reviewed by the UNC Office of Human Research Ethics and was determined to be exempt from further review. Study Setting The LCCC telemedicine program implemented a VTB in 2010 to enable community-based clinicians to participate, free of charge, in the multidisciplinary tumor boards of various cancer specialties within UNC Health Care. UNC VTB leadership contacted of a v Irtual t uM or b oard p rograM community-based clinicians they believed might be interested in the VTB. Those interested were provided, free of charge, the necessary technology and technical assistance to access the tumor boards from a central conference room in their facility or from their personal computers via a secured interactive video network. Depending on technology already present at the collaborating facility, any needed additional equipment (e.g., monitors, cameras) was purchased using the University Cancer Research Fund. At the UNC location, each tumor board used the same conference room and technology, with video screens displaying the clinician(s) presenting the case as well as pathology slides and/or radiology images. For any tumor board meeting, participating community-based clinicians could request to present a case or simply participate in discussion of other cases. LCCC telemedicine program staff coordinated scheduling of all cases presented by community-based clinicians. Generally, these virtual cases were integrated into the regularly scheduled UNC tumor board meeting (although one cancer specialty began 30 minutes prior to the usual meeting time when its participants had a virtual case to discuss and then continued with discussion of internal [UNC] cases). Each tumor board had multidisciplinary participation from UNC, including medical oncologists, radiation oncologists, surgeons, radiologists, pathologists, oncology nurses, and other clinical and research staff. Prior to the communitybased clinician's presentation of the case, a UNC oncologist typically reviewed the case and prepared for the 179

Table of Contents for the Digital Edition of Journal of Healthcare Management - May/June 2014

Journal of Healthcare Management - May/June 2014
Contents
Interview With Christopher D. Van Gorder, FACHE, President and CEO of Scripps Health
Successful Strategic Planning for a Reformed Delivery System
You, Inc.
Assessing the Feasibility of a Virtual Tumor Board Program: A Case Study
Physician Clinical Alignment and Integration: A Community–Academic Hospital Approach
Employer-Based Coverage and Medical Travel Options: Lessons for Healthcare Managers
Composite Model for Profiling Physicians Across Domains of Care

Journal of Healthcare Management - May/June 2014