Great strides have been made in computerization of ordering processes for general medications and chemotherapy agents. However, systems for ordering, processing, and administration of cellular therapies continue to be largely paper-based, without the safety features of computerized order entry. To address this deficit, Partners Healthcare System Information Services (PHS-IS; Boston, MA) has worked with oncologists and staff in the cell processing laboratory at the Dana-Farber Cancer Institute (Boston, MA) to develop and implement a novel, comprehensive computerized system for physician ordering and management of cellular products. A multidisciplinary team was formed to accomplish the task of developing a cellular product management system. This team identified the unique characteristics of cellular therapies and sought to develop a comprehensive computerized system that addressed these needs. The biotherapy order entry system developed and implemented by PHS-IS includes a suite of three interrelated applications that addresses all requirements of a traditional computerized provider order entry system, as well as features unique to cellular therapies. The biotherapy suite of applications has addressed patient safety concerns, streamlined the ordering of cellular therapy products, and has reduced opportunities for error and delay in product administration.
Case VignetteA 9-month-old baby is battling leukemia, and a bone marrow transplant derived from the hematopoietic stem cells of a frozen umbilical cord presents her best chance for survival. Laboratory technologists at Dana-Farber Cancer Institute's (DFCI) Cell Manipulation Core Facility (CMCF) will follow a complex procedure to thaw an umbilical cord blood product collected from a healthy baby from a cryopreserved state and prepare it for transplantation. 9:00 AM: Time is a critical factor in this process; the reconstituting stem cells that comprise umbilical cord products do not survive outside the body for long periods of time. They must be infused into the patient within 4 hours of being thawed. In this narrow window of time, all patient and donor demographics and ordering information must be verified to be correct; the product must be thawed and prepared for transplant by laboratory technologists and infused into the patient by her nurse.The baby's nurse and a technologist schedule an infusion time of 11:00 AM. This should provide ample time for the technologist to prepare the cord blood for transplant into the patient before the product's 1:00 pm expiration time.At DFCI, all orders for cellular therapies, such as umbilical cord blood products, are on paper. Laboratory supervisors and technologists must rely completely on human vigilance to scan orders for completeness and accuracy; however, they have not noticed that the baby's oncologist has omitted her weight on the order for thawing and processing these cells.10:30 AM: At 90 minutes after thawing, with the product viability beginning its natural decline, the technologist follows standard procedu...