Coordinated Care Tracking System (CCTS)

Authors: Tamar Taddei, MD, Janice Schwartz, RN and Richelle Coraza, RN

The Coordinated Care Tracking System (CCTS) is an application designed to ensure timely and appropriate coordination of care through identification, tracking, and navigating Veterans at-risk or affected by cancer throughout the continuum of care from screening to survivorship. Developed and maintained at VA Connecticut, this web-based tool offers direct connection to the VA’s Enterprise Data (VA Corporate Data Warehouse/Summit Data Platform). The application facilitates identifying at-risk patients who would benefit from cancer screening and recall. The standardized application provides configurable queues for tracking abnormal imaging and pathology so that findings concerning for malignancy can be rapidly triaged to care. Patient outcomes are greatly enhanced through timely access to care and the elimination of delays in cancer diagnosis and treatment (Zhang et al. Plos Digital Health. 2022. PMID 36812575; Alsamarai et al. Clin Lung Cancer. 2013. PMID 23827516).

The CCTS has been in daily use at VA Connecticut since 2010. Since then, its use has expanded to over half of VA stations and to 17 of 20 VISNs. From a CCTS user’s perspective, one of the benefits of this tracking system is having customer support readily available. There are monthly CCTS field meetings for users and developers to discuss new features, issues, or ideas. On-line training sessions are offered throughout the week and are available to all users (new or current). The CCTS developers continually enhance the tracking system through iterative design informed by users and subject matter experts. This application provides a robust solution to centralize and facilitate identification and tracking of Veterans requiring complex care coordination.

For more information, please see this one page information sheet below.