June 26, 2023
June 26, 2023
A digitalhealth.net webinar, supported by Parsek, explored what the latest research has discovered about the efficiency and effectiveness of multi-disciplinary team meetings. It also discussed how digital integration and collaboration platforms can help to address the issues, informed by experience from The Netherlands.
Multi-disciplinary team meetings are the “gold standard” for making cancer diagnoses and treatment decisions.
Ben Lamb, a Barts Health and UCLH surgeon and researcher, told in a recent webinar that they are backed by the NHS and cancer bodies because they can reduce variability and improve quality by bringing together the different specialists involved in a patient’s care.
However, they face challenges. As the population ages, the number of patients with cancer is rising, and cases are becoming more complex. Meetings are getting longer, so the administrative burden of getting them together is increasing, and clinicians are finding it harder to work through all the cases in front of them while following best-practice guidance.
“Over the past decade, we have tried to improve efficiency by focusing on the most complex cases,” Lamb told at the webinar. “We have also seen the introduction of tools to try to support them.”
Even so, research has suggested that between 18% and 52% of case discussions don’t end with a decision, and between 4% and 19% of the decisions that are made can’t be implemented.
Findings from the latest research on MDT meetings
Lamb’s colleague, Tayana Soukup, a researcher from Imperial College London, elaborated on some of the reasons for this. The guidance for MDT meetings emphasises the importance of securing input from a diverse range of professionals, but when meetings are observed, some professionals contribute more than others.
Surgeons, for example, tend to contribute more than specialist nurses – even though nurses tend to have information about the patient’s circumstances. The quality of communication tends to reduce over time, and sometimes lack of necessary patient information means that the treatment plan cannot be reached at the point of the meeting. So they end up being moved to another meeting, impacting its workload, delaying care for the patient, and increasing the cost for the NHS.
Data and collaboration platforms in action in The Netherlands
Dr Peter-Paul Willemse, an oncological urologist from UMC Utrecht in the Netherlands, outlined how Oncomid, a regional alliance of seven hospitals and one academic medical centre, deployed Parsek’s collaboration platform to support its 13 tumour boards.
Like services in the UK, he said his own speciality was facing a rising number of new cases – as many as 50-60 per week – which was making it harder and harder to get the 20-25 specialists who needed to discuss them together. Plus, he said, the hospitals were using different electronic patient record systems, which made it hard to share patient information.
Oncomid also wanted to make information available ahead of time, so clinicians could review it and advise on straightforward cases outside the MDT meeting itself, create a structure for discussions, and capture decisions and advice in a way that could be sent to GPs within 24 hours.
“In the Netherlands, we are lucky that there are only five EPRs, compared to Belgium, where there are lots,” he said. “So, we needed to make it possible for all these EPRs to communicate. The Parsek’s Vitaly e-health platform created a digital environment for MDT preparation and support [for our desired] workflow.”
The Parsek solution also integrates with a calendar solution and Microsoft Teams, so MDT meeting participants can join by video conferencing call. The deployment has improved efficiency, Willemse said. It has also made it possible to review the quality of decision-making by generating data on the number of and type of cases that have been reviewed and how many were left incomplete or sent for repeat review.
Automation improves data: and lets clinicians get on with their jobs
In response to a question from a webinar attendee, who asked how technology can be used to support cross-organisational MDT meetings, Lamb argued IT that can support participants at hospitals using different EPRs is going to be “essential” as provider groups and cancer networks continue to develop.
Antonia Wells, a cancer lead and consultant at West Suffolk NHS Foundation Trust, which has recently signed up for the Parsek collaboration platform, added that it’s not just EPR data that’s needed. Her organisation is anxious to link-in data from the Somerset Cancer Register, which is used for the management of cancer, as well as reporting on cancer performance.
In response to another question about how to make sure that good quality data is available to meeting participants, she argued that automation has to be the way forward. “Minimising the number of times that people have to put data in helps,” she said, adding that she didn’t want highly qualified, scarce cancer specialists spending their time retyping data into lists, spreadsheets and data platforms.
More research is needed
Technology won’t solve all the problems facing MDT meetings. It won’t even solve the problems that it can solve unless it is implemented effectively, and both Lamb and Soukup argued it will be important to study new implementations to find out more about what works, why and under what circumstances (what might be the barriers, and what adaptations are needed to make it work effectively).
“Technology is advancing rapidly, and research needs to catch up,” Soukup said. “We need to know about implementation problems and how to overcome them so that we can understand how to do this.” Also, she added, mental health, dementia, and other specialisms dealing with chronic conditions make heavy use of MDT meetings.
But they’ve yet to undertake the kind of research studies into their effectiveness that cancer has undertaken or started to adopt technology at the same scale. So, there’s a lot for them to learn from cancer care and digital platform deployments like the one at West Suffolk, which is going to be studied by Lamb and Soukup and their teams.
Willemse concluded the webinar by saying that, from his experience in The Netherlands, success factors include getting clinicians involved early and really understanding what they want from a digital platform. Do that, he said, and: “You can make decisions and have quality for the patient from the MDT.”
About the panel
The webinar took place on 20 June 2023 and was chaired by Jon Hoeksma, chief executive of Digital Health. The speakers were: Tayana Soukup, BSc, MSc, PhD, FRSPH, CPsychol, a researcher on cancer multidisciplinary teams – Imperial College London; Benjamin W Lamb, MBBS MA PhD. FRCS (Urol), consultant urological and robotic surgeon – Barts Health and University College London Hospital NHS trusts and honorary senior lecturer, Barts Cancer Institute; and Dr Peter-Paul Willemse, a urological oncologist – UMC Utrecht, and head of the Oncological Urology Board – Oncomid – in The Netherlands, and Antonia Wells, Cancer Lead and Consultant Surgeon – West Suffolk NHS Foundation Trust.