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

BackgroundToday, cancer documentation is still a tedious task involving many different information systems even within a single institution and it is rarely supported by appropriate documentation workflows.MethodsIn a comprehensive 14 step analysis we compiled diagnostic and therapeutic pathways for 13 cancer entities using a mixed approach of document analysis, workflow analysis, expert interviews, workflow modelling and feedback loops. These pathways were stepwise classified and categorized to create a final set of grouped pathways and workflows including electronic documentation forms.ResultsA total of 73 workflows for the 13 entities based on 82 paper documentation forms additionally to computer based documentation systems were compiled in a 724 page document comprising 130 figures, 94 tables and 23 tumour classifications as well as 12 follow-up tables. Stepwise classification made it possible to derive grouped diagnostic and therapeutic pathways for the three major classes- solid entities with surgical therapy- solid entities with surgical and additional therapeutic activities and- non-solid entities.For these classes it was possible to deduct common documentation workflows to support workflow-guided single-source documentation.ConclusionsClinical documentation activities within a Comprehensive Cancer Center can likely be realized in a set of three documentation workflows with conditional branching in a modern workflow supporting clinical information system.

[1]  C. Ko,et al.  The National Cancer Data Base: A Powerful Initiative to Improve Cancer Care in the United States , 2008, Annals of Surgical Oncology.

[2]  Martin Dugas,et al.  The need for harmonized structured documentation and chances of secondary use - Results of a systematic analysis with automated form comparison for prostate and breast cancer , 2014, J. Biomed. Informatics.

[3]  Jacques Bouaud,et al.  ONCODOC: a successful experiment of computer-supported guideline development and implementation in the treatment of breast cancer , 2001, Artif. Intell. Medicine.

[4]  M. Beckmann,et al.  An EMR based cancer diary - utilisation and initial usability evaluation of a new cancer data visualization tool. , 2012, Studies in health technology and informatics.

[5]  A. Tannapfel,et al.  [Report on the workshop "workflow rectal cancer II" in Burghausen]. , 2007, Zentralblatt fur Chirurgie.

[6]  Gottfried Vossen,et al.  Single Source Information Systems to Connect Patient Care and Clinical Research , 2009, MIE.

[7]  Ron Kikinis,et al.  Workflow modeling and analysis of computer guided prostate brachytherapy under MR imaging control. , 2004, Studies in health technology and informatics.

[8]  Universitäts-Hautklinik Heidelberg,et al.  Integration von Therapieplanung und standardisierter Dokumentation - Ergebnisse aus der Entwicklung und Einführung eines rechnerbasierten Anwendungssystems der Pädiatrischen Onkologie , 2004 .

[9]  Mark J Halsted,et al.  Design, implementation, and assessment of a radiology workflow management system. , 2008, AJR. American journal of roentgenology.

[10]  Ricardo Pietrobon,et al.  Workflow in Clinical Trial Sites & Its Association with Near Miss Events for Data Quality: Ethnographic, Workflow & Systems Simulation , 2012, PloS one.

[11]  Philip R. O. Payne,et al.  Standardizing Clinical Trials Workflow Representation in UML for International Site Comparison , 2010, PloS one.

[12]  Hans-Ulrich Prokosch,et al.  IT Infrastructure Components to Support Clinical Care and Translational Research Projects in a Comprehensive Cancer Center , 2011, MIE.

[13]  Reinhold Haux,et al.  Individualization, globalization and health - about sustainable information technologies and the aim of medical informatics , 2006, Int. J. Medical Informatics.

[14]  Hans-Ulrich Prokosch,et al.  Workflows in Cancer Treatment and their Influence upon Clinical Documentation , 2013, MedInfo.

[15]  E Ammenwerth,et al.  The Time Needed for Clinical Documentation versus Direct Patient Care , 2009, Methods of Information in Medicine.

[16]  K. Buetow,et al.  Cancer Informatics Vision: caBIG™ , 2006, Cancer informatics.

[17]  M. Beckmann,et al.  Single-Source Tumor Documentation - Reusing Oncology Data for Different Purposes , 2013, Oncology Research and Treatment.

[18]  C. Street,et al.  The Cancer Biomedical Informatics Grid (caBIGTM) , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[19]  Larry A Nathanson,et al.  Where's the beef? The promise and the reality of clinical documentation. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[20]  Martin Dugas,et al.  HIS-based electronic documentation can significantly reduce the time from biopsy to final report for prostate tumours and supports quality management as well as clinical research , 2009, BMC Medical Informatics Decis. Mak..

[21]  H. Schmoll,et al.  Kompendium Internistische Onkologie Standards in Diagnostik und Therapie , 1999 .

[22]  M. Hünerbein,et al.  [Diagnosis of and therapy for gastric cancer--work-flow]. , 2009, Zentralblatt fur Chirurgie.

[23]  Katharina Kaiser,et al.  Computer-interpretable Guideline Formalisms , 2008, Computer-based Medical Guidelines and Protocols.

[24]  Johannes Bernarding,et al.  Digital workflow management for quality assessment in pathology. , 2008, Pathology, research and practice.

[25]  Enhancing patient safety and quality of surgical cancer care: the French National Cancer Plans. , 2010, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[26]  Hans-Ulrich Prokosch,et al.  Implementation of a Patient Data Management System - An evaluation study of workflow alterations , 2010, MedInfo.

[27]  J Dudeck,et al.  Stepwise Evaluation of Information Systems in an University Hospital , 1999, Methods of Information in Medicine.

[28]  Alfred Winter,et al.  Management von Informationssystemen: Analyse, Bewertung, Auswahl, Bereitstellung und Einführung von Informationssystemkomponenten am Beispiel von Krankenhausinformationssystemen , 1998, Management von Informationssystemen.

[29]  J. Robert Beck,et al.  The Cancer Biomedical Informatics Grid (caBIG‚): An Evolving Community for Cancer Research , 2010 .

[30]  Arie Hasman,et al.  Approaches for creating computer-interpretable guidelines that facilitate decision support , 2004, Artif. Intell. Medicine.

[31]  R Haux,et al.  Systematic planning of clinical documentation. , 1996, Methods of information in medicine.

[32]  A. Engert,et al.  Hämatologie und internistische Onkologie , 1999, Der Internist.

[33]  Joachim Dudeck,et al.  A Reference Model for Clinical Tumour Documentation , 2006, MIE.

[34]  Udo Kelter,et al.  Bericht über den Workshop , 2007, Softwaretechnik-Trends.

[35]  Tillal Eldabi,et al.  An Integrated Methodology for Process Improvement and Delivery System Visualization at a Multidisciplinary Cancer Center , 2013, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[36]  Reinhold Haux,et al.  Health information systems - past, present, future , 2006, Int. J. Medical Informatics.

[37]  William E. Copeland,et al.  Department of Obstetrics and Gynecology , 1893, Texas medical journal.

[38]  F A Sonnenberg,et al.  Computer-Interpretable Clinical Practice Guidelines , 2006, Yearbook of Medical Informatics.

[39]  Thomas Bürkle,et al.  Clinical Pathways Development and Computer Support in the EPR: Lessons learned , 2006, MIE.

[40]  P Hermanek,et al.  [Diagnosis and treatment of colorectal liver metastases - workflow]. , 2008, Zentralblatt fur Chirurgie.

[41]  M. Beckmann,et al.  Certification of breast centres in Germany: proof of concept for a prototypical example of quality assurance in multidisciplinary cancer care , 2009, BMC Cancer.

[42]  Joachim Dudeck,et al.  Integrated decision support in a hospital cancer registry , 2002, Artif. Intell. Medicine.

[43]  Richard W. Grant,et al.  Application of Information Technology: Mammography FastTrack: An Intervention to Facilitate Reminders for Breast Cancer Screening across a Heterogeneous Multi-clinic Primary Care Network , 2009, J. Am. Medical Informatics Assoc..

[44]  Felicia M Bowens,et al.  Health information technology: integration of clinical workflow into meaningful use of electronic health records. , 2010, Perspectives in health information management.

[45]  R. Haux,et al.  Soarian--workflow management applied for health care. , 2003, Methods of information in medicine.

[46]  H. Buhr,et al.  Klinischer Ablaufpfad (Workflow) zu Diagnostik, Therapie und Nachsorge des Rektumkarzinoms , 2006 .

[47]  Zhibin Jiang,et al.  An ontology-based hierarchical semantic modeling approach to clinical pathway workflows , 2009, Comput. Biol. Medicine.

[48]  The Cancer Council NSW Towards a National Cancer Data Strategy for Australia , 2008 .