Cross-enterprise Tumor Board Workflow Definition
Screening, diagnosis, treatment and aftercare of oncological patients require cooperation of a multidisciplinary team of healthcare professionals. Typically, an oncological care pathway is both multidisciplinary and often cross-enterprise, including participants from different specialisms and different hospitals. In order to be able to work together and study the different patient cases, the participating specialists, radiologists, pathologists, nurses and paramedics must have access to the relevant medical information. They also need an overview of the current status of the process to see whether the required information is available.
XTB-WD profile defines an XDW based workflow aimed to manage the creation and the execution of a tumor board.
The Cross-enterprise Tumor Board Workflow Definition (XTB-WD) describes the different Tasks of a Tumor Board Review process, and the accompanying information in the form of input- and output documents that are linked to the different Tasks in the process. The XTB-WD describes a relatively small part of a larger workflow definition, in this case an oncological care pathway. Other parts of the oncological pathway can be defined in a later stage, in other Workflow Definitions. The different Workflow Definitions can be seen as ‘building blocks’ that describe the actual care pathway of an individual patient. Below is a schematic overview of the place of the XTB Workflow Definition (XTB-WD) in an oncological pathway:
During a care episode, different Workflow Definition documents describe the actual steps of the care pathway. The unpredictability of the different steps or tasks in a care episode requires a flexible method that allows the total process to be divided into smaller Workflow Definitions. The XTB-Workflow Definition is one of those building blocks. By linking different WD documents, the relation between the different XDW documents can be created. For the correct management of a Tumor Board Review, each of the participants of the Tumor Board must have the possibility to share all relevant medical information. Currently, this is not possible, as there are no standardized means of monitoring and managing the different stages of the workflow, or of the documents that are created and attached in these different Tasks. The key elements for improvement of the current processes are:
- Managing the TBR workflow
- Tracking the relevant events and related documents
- Tracking the status of each subtask in the workflow
- Access to all relevant images, reports and other documents created in (or used in) the process
- Linking the created documents to the different Tasks in the process, thereby defining the context of these documents.
In the current situation, problems arise at all of the above stages:
1. Request TBR
Specialists complain about the cumbersome process of gathering the necessary images, reports, and excerpts from their EPR. Currently, texts are faxed (and have to be re-entered into the electronic patient record EPR of the hospital where the TB meeting is held), and images are sent by CD or DVD. The images and reports on these cd’s have to be linked manually to the right patient in the receiving HIS/EPR. This is a time consuming and error-prone process.
2. Schedule TBR
The chairperson of the Tumor Board has to decide whether the patient fits the constraints for the particular TB meeting, and whether all necessary documents and images are available. If the maximum number of patients has been reached, the chairperson has to determine which patients can be postponed to a later TB meeting. These tasks are time-consuming and often require extra phone calls to the requestor. There is no overview of the status of all requests.
3. Prepare TBR
In the current situation, results from diagnostic studies such as CT scans, X-ray images and endoscopic images can only be seen by the radiologist. Faxes have to be copied if someone wishes to prepare the TB meeting beforehand. In most cases, preparation is not possible for most team members except the radiologist. Also, tracking whether the required documents are available is a time-consuming chore.
4. TBR Meeting
During the TB Meeting, sometimes patients that were scheduled cannot be discussed because DVD’s have not arrived on time, or not at the right address, or have not yet been linked to the patient. Since the patient come from different hospitals, the medical information is presented in different ways, on different EPR systems. Since most participants have never met the patients they discuss, this can lead to confusion. Also, the notes that are taken during the discussion of a patient can often not be seen or checked by the all participants. During the TB Meeting, a scribe writes down the findings, conclusions and recommendations for treatment of the patient. These texts have to be checked and validated by the chairperson.
5. Finalize TBR
After the TB meeting, the validated findings, conclusions and recommendations are incorporated into a Tumor Board Review Report. The TBR report is then ready for distribution to the Requestor, and /or other designated healthcare professionals. In the current situation, this is a time consuming process, with manual insertion of the texts into a document that is not automatically created or distributed.
- Hospital Information System
- Oncological EHR
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