EP243 - Implementing an Informatics-Based “Health Maintenance Plan” to Enhance Watch-and-Wait Rectal Cancer Surveillance

Sunday, May 10, 2026

8:21 AM - 8:26 AM ET

ePoster Presenter(s)

Jon Freise, MD

Resident Physician
UCSF
UCSF
San Francisco, CA, United States

Disclosure information not submitted.

Author(s)

CM

Caleb Matthews, Registered Nurse

Registered Nurse
UCSF
San Francisco, California, United States

Disclosure information not submitted.
HC

Hueylan Chern, MD

Professor of Surgery
University of California, San Francisco
San Francisco, California, United States

Disclosure information not submitted.
Elizabeth C. Wick, MD

Professor of Surgery
University of California, San Francisco
University of California, San Francisco
San Francisco, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
EF

Emily Finlayson, MD, MS

Professor of Surgery
University of California, San Francisco
San Francisco, CA, United States

Disclosure information not submitted.
Madhulika G. Varma, MD

Professor of Surgery
University of California, San Francisco
San Francisco, California, United States

Disclosure information not submitted.

Senior Author(s)

B. Mark Zhao, University of California, San Francisco

Assistant Professor of Clinical Surgery
University of California, San Francisco
San Francisco, CA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Elizabeth C. Wick, MD: This individual has no financial relationships with ineligible companies.

B. Mark Zhao, University of California, San Francisco: This individual has no financial relationships with ineligible companies.

Purpose/Background: Watch-and-Wait (WW) represents a paradigm shift in the treatment of rectal cancer. It is an exciting organ-preservation strategy for rectal cancer, but up to one-third of patients on WW may experience local regrowth or distant recurrence. Therefore, strict adherence to surveillance is required for timely management of regrowth. However, adherence to WW surveillance protocols may be challenging for patients and checking adherence is arduous for providers. A new centralized informatics-based "health maintenance plan" (HMP) was developed to automatically track patient adherence to radiographic, serologic, and endoscopic modalities based on our institution's WW surveillance protocol. The HMP was also designed to ease the burden in checking adherence on individual patients by centralizing the data into a single registry (Figure 1).

Methods/Interventions: After extensive iterative testing, the HMP was activated in the electronic medical record (EMR). Immediately prior to activation, the provider facing tool was demonstrated to colorectal surgeons, medical oncologists, and a nurse navigator during a virtual interactive education session. Clinicians were surveyed on their WW surveillance practices 4 months after the activation. Data was subsequently collected on the utilization of the WW reports within the EMR at 5 months.

Results/Outcomes: Retrospective utilization data revealed that only 25% (4/16) providers utilized the WW HMP tool. Among this group, 55% of reports were generated by a single colorectal surgeon, 42% of reports by a nurse navigator, and 3% of reports by a medical oncologist. Eleven clinicians (73% medical oncologists, 27% colorectal surgeons) were surveyed on their WW surveillance practices. This survey revealed highly variable practice patterns for monitoring WW surveillance. Providers noted a lack of awareness of the tool, uncertainty about how to use the tool, and unclear responsibility of who should be primarily using the tool. When asked who should oversee WW surveillance adherence, respondents selected medical oncologists (n=5), followed by nurse navigator (n=4) and surgeons (n=1).

Conclusion/Discussion: Evaluation of our early implementation data suggests poor integration of the WW HMP tool into providers' clinical workflow. While the WW HMP tool was designed to streamline and centralize communications with the goal of reducing time burden for clinicians, our early experience suggests that more training may be needed. This data also demonstrates the workflow complexities of the multidisciplinary group of providers involved in WW surveillance, which may require multilevel interventions. Clarification of roles and responsibilities may help improve future efforts to implement informatics-based tools into WW surveillance protocol.

Figure 1

A represented snapshot of the report generated by the automated "Health Maintenance Plan", which is integrated into the electronic medical record and patient portal, showing up-to-date surveillance data for each modality in WW surveillance.