Analysis and classification of oncology activities on the way to workflow based single source documentation in clinical information systems

Wagner, Stefan; Beckmann, Matthias W.; Wullich, Bernd; Seggewies, Christof; Ries, Markus; Bürkle, Thomas; Prokosch, Hans‐Ulrich

doi:10.1186/s12911-015-0231-x

Cited by 8 publications

(3 citation statements)

References 32 publications

(20 reference statements)

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“…Conversely, CPOE can introduce new types of error and have unexpected negative consequences on work practices [ 1 , 17 ]. It can also be challenging to implement CPOE for chemotherapy [ 15 , 16 , 18 , 19 ], with every chemotherapy protocol having to be entered in the system and then kept up to date [ 15 , 20 ]. Adoption of CPOE for chemotherapy can thus lag behind adoption of CPOE systems for other medications or in other clinical areas [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy

Lichtner

Franklin

Dalla‐Pozza

et al. 2020

BMC Med Inform Decis Mak

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Background: There are serious safety risks associated with chemotherapy, often associated with interdependencies in regimens administered over months or years. Various strategies are used to manage these risks. Computerized provider order entry (CPOE) systems are also implemented to improve medication safety. Little is known regarding the effect of CPOE on how clinicians manage chemotherapy interdependencies and their associated safety strategies. Methods: We conducted a multi-method qualitative study in a paediatric hospital. We analysed 827 oncology incidents reported following CPOE implementation and carried out semi-structured interviews with doctors (n = 10), nurses (n = 6), a pharmacist, and oncology CPOE team members (n = 2). Results were interpreted according to safety models (ultra-safe, high-reliability organisations [HROs], or ultra-adaptive). Results: Incident reports highlighted two interrelated types of interdependencies: those within organisation of clinical activities and those inherent in chemotherapy regimens. Clinicians reported strategies to address chemotherapy risks and interdependencies. These included rigid rules and 'no go' contexts for treatment to proceed, typical of the ultra-safe model; use of time (e.g. planning only so far ahead) and sensitivity to operations, typical of HROs. We identified three different time horizons in CPOE use in relation to patients' treatments: lifelong , the whole regimen, and the 'here and now'. CPOE supported ultra-safe strategies through automation and access to rules/standardisation, but also created difficulties and contributed to incidents. It supported the 'here and now' better than a lifelong or whole regimen view of a patient treatment. Sensitivity to operations was essential to anticipate and resolve uncertainties, hazards, CPOE limitations, and mismatches between CPOE processes and workflow in practice.

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Section: Introductionmentioning

confidence: 99%

Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy

Lichtner

Franklin

Dalla‐Pozza

et al. 2020

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

show abstract

“…Conversely, CPOE can introduce new types of error and have unexpected negative consequences on work practices (1,17). It can also be challenging to implement CPOE for chemotherapy (15,16,18,19), with every chemotherapy protocol having to be entered in the system and then kept up to date (15,20).…”

Section: Introductionmentioning

confidence: 99%

Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy

Lichtner

Franklin

Dalla‐Pozza

et al. 2020

Preprint

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Background: There are serious safety risks associated with chemotherapy, often associated with interdependencies in regimens administered over months or years. Various strategies are used to manage these risks. Computerized provider order entry (CPOE) systems are also implemented to improve medication safety. Little is known regarding the effect of CPOE on how clinicians manage chemotherapy interdependencies and their associated safety strategies.Methods: We conducted a multi-method qualitative study in a paediatric hospital. We analysed 827 oncology incidents reported following CPOE implementation and carried out semi-structured interviews with doctors (n=10), nurses (n=6), a pharmacist, and oncology CPOE team members (n=2). Results were interpreted according to safety models (ultra-safe, high-reliability organisations [HROs], or ultra-adaptive). Results: Incident reports highlighted two interrelated types of interdependencies: those within organisation of clinical activities and those inherent in chemotherapy regimens. Clinicians reported strategies to address chemotherapy risks and interdependencies. These included rigid rules and ‘no go’ contexts for treatment to proceed, typical of the ultra-safe model; use of time (e.g. planning only so far ahead) and sensitivity to operations, typical of HROs. We identified three different time horizons in CPOE use in relation to patients’ treatments: life-long, the whole regimen, and the ‘here and now’. CPOE supported ultra-safe strategies through automation and access to rules/standardisation, but also created difficulties and contributed to incidents. It supported the ‘here and now’ better than a life-long or whole regimen view of a patient treatment. Sensitivity to operations was essential to anticipate and resolve uncertainties, hazards, CPOE limitations, and mismatches between CPOE processes and workflow in practice. Conclusions: Within oncology, CPOE appears to move the ‘mix’ of risk strategies towards ultra-safe models of safety and protocol-mandated care. However, in order to operate ultra-safe strategies embedded in CPOE and stay on protocol it is essential for clinicians to be thoughtful and show sensitivity to operations in CPOE use. CPOE design can be advanced by better consideration of mechanisms to support interdependencies.

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“…Medical data are frequently distributed across multiple electronical information systems of several departments in different forms of documentation styles (9). Although most university hospitals already implemented commercial hospital information systems and started to develop comprehensive EHRs, there is still a gap between clinical care and using this data for medical research that needs to be filled (10, 11). Recent studies have focused on providing routine clinical data for research purposes, e.g., by using a single-source tumor documentation or supporting systems for patient recruitment into clinical trials in the field of radiation oncology (12) and intensive care (13).…”

Section: Introductionmentioning

confidence: 99%

Electronic Support for Retrospective Analysis in the Field of Radiation Oncology: Proof of Principle Using an Example of Fractionated Stereotactic Radiotherapy of 251 Meningioma Patients

et al. 2017

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IntroductionThe purpose of this study is to verify the possible benefit of a clinical data warehouse (DWH) for retrospective analysis in the field of radiation oncology.Material and methodsWe manually and electronically (using DWH) evaluated demographic, radiotherapy, and outcome data from 251 meningioma patients, who were irradiated from January 2002 to January 2015 at the Department of Radiation Oncology of the Erlangen University Hospital. Furthermore, we linked the Oncology Information System (OIS) MOSAIQ® to the DWH in order to gain access to irradiation data. We compared the manual and electronic data retrieval method in terms of congruence of data, corresponding time, and personal requirements (physician, physicist, scientific associate).ResultsThe electronically supported data retrieval (DWH) showed an average of 93.9% correct data and significantly (p = 0.009) better result compared to manual data retrieval (91.2%). Utilizing a DWH enables the user to replace large amounts of manual activities (668 h), offers the ability to significantly reduce data collection time and labor demand (35 h), while simultaneously improving data quality. In our case, work time for manually data retrieval was 637 h for the scientific assistant, 26 h for the medical physicist, and 5 h for the physician (total 668 h).ConclusionOur study shows that a DWH is particularly useful for retrospective analysis in the radiation oncology field. Routine clinical data for a large patient group can be provided ready for analysis to the scientist and data collection time can be significantly reduced. Furthermore, linking multiple data sources in a DWH offers the ability to improve data quality for retrospective analysis, and future research can be simplified.

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Analysis and classification of oncology activities on the way to workflow based single source documentation in clinical information systems

Cited by 8 publications

References 32 publications

Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy

Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy

Electronic ordering and the management of treatment interdependencies: a qualitative study of paediatric chemotherapy

Electronic Support for Retrospective Analysis in the Field of Radiation Oncology: Proof of Principle Using an Example of Fractionated Stereotactic Radiotherapy of 251 Meningioma Patients

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