Next-generation long-term transplant clinics: improving resource utilization and the quality of care through health information technology

Abstract

By the year 2020, potentially one half million hematopoietic cell transplant (HCT) recipients will need long-term follow up care to address not only chronic GvHD but also multiple other late consequences of transplant. Despite this increase in patients, there will not be a concomitant increase in the HCT workforce. Thus the future of long-term patient management will require a new “next-generation” clinical model that utilizes technological solutions to make the care of the HCT patient efficient, safe, and cost-effective. Guideline-based decision support will be embedded in clinical workflows. Documentation requirements will be reduced as automated data collection from electronic medical records (EMRs) will populate registries and provide feedback for a rapid learning health system. Interoperable EMRs will disseminate treatment protocols to multiple care providers in a distributed long-term clinic model, such that providers outside of the transplant center can provide services closer to the patient. Patients will increase their participatory role through patient portals and mobile devices. At Vanderbilt, we have responded so some of these future challenges by embedding guideline-based decision support, structuring clinical documentation, and being early adopters of communication technology. This manuscript describes the current state of some of these innovations, and a vision for the future of the long-term transplant clinic.

The Heimdall framework for supporting characterisation of learning health systems

“…Technology is fundamental to LHS. As EBM evolves from paper-based roots, clinicians and healthcare providers will realise benefits from coupling technology to Learning Health Organisations, thus realising LHS 79 , 84…”

Multimorbidity and medication complexity: New challenges in heart transplantation

“…First, comprehensive healthcare programs carried out by proactive multidisciplinary teams allow focus on disease prevention and patient empowerment . In this regard, new Internet‐based tools could facilitate the cost‐effective implementation of these programs in the SOT population …”

Supportive (Maintenance) Therapy in Hematopoietic Stem Cell Transplantation: Main Principles and New Perspectives

“…Использование информационных технологий (медицинские информационные системы, мобильные приложения для врачей и пациентов) позволит улучшить качество СТ, в т. ч. и при необходимости про-должительного наблюдения за длительно живущими реципиентами ТГСК [85].…”

“…В 2003 г. медицинский центр университета Вандербильта (штат Теннесси, США) разработал и внедрил трансплантационную про-грамму на основе цифровых технологий с шаблонами записей для всех этапов и видов ТГСК (подготовка, мобилизация, ауто-, аллоТГСК, визиты после ТГСК), а также возможность включения больных в клини-ческие исследования [85]. Программа соединена с медицинской информационной системой пациента (анамнестические, клинико-лабораторные и инстру-ментальные данные).…”