Background
UMC Utrecht is one of the top-ranked academic medical centres in Europe. Since January 2019, UMC Utrecht, Meander Medical Centre (20 km from UMC Utrecht) and Tergooi hospital (17 km from UMC Utrecht) have started a collaboration in the field of urological cancer care. Following the modern multidisciplinary approach by combining cross-hospital knowledge and experience, the three hospitals aim to jointly improve the quality of care for people with bladder, kidney and prostate cancer. The cooperation between the three institutions involves specialisation in one type of cancer surgery, namely bladder removal – cystectomy (UMC Utrecht), prostate removal – Robotic Assisted Laparoscopic Prostatectomy (Meander MC) and kidney removal – laparoscopic nephrectomy (Tergooi hospital).
Challenge
The complex cases in need of joint decision-making are presented at joint weekly MDOs (Multidisciplinair overleg’s) to regularly discuss and align on the management of such difficult cases. Within the established MDOs, the customer and the partner institutions were experiencing:
- collaboration with no standardised and structured framework in place;
- costly administration and unreliable data sharing;
- on-premises meeting facilitation that resulted in travelling or affected attendance rate;
- administration errors and duplicates due to lack of process overview;
- a strive to be more compliant with standards and legislation.
Aim
UMC Utrecht approached Parsek to improve the way they collaborate and facilitate the existing MDO, which could spread the MDO governance over the entire Utrecht region.
With the installation of regional virtual MDOs, UMC Utrecht is enabled for:
- Standardised collaboration framework enabling easy-to-scale and more uniformed approach;
- Streamlined administration and integrated data sharing with minimised manual efforts;
- Facilitated weekly MDOs where 50 patients on average are being reviewed by the specialists from 3 medical institutions participating remotely;
- Improved governance with a clear overview over the process and the possibility to track and trace single requests for better planning and minimisation of duplicated cases;
- Stimulated discussion and case review in the preparation phase to increase the MDO efficiency;
- Pursuing an interoperable approach supported by IHE XTB-WD workflow and standard integrations to increase compliance and sustainability.
Solution
The Vitaly solution for Multidisciplinary Team Meetings has been recognised as suitable to sit on top of the regional XDS to follow the goals mentioned above. Yet, the first implementation was critical in bringing a closer look at how this collaborative and integrated model can really work in practice.
The solution was delivered in partnership with Cisco Netherlands and Open Line. It connected three partner institutions on a regional level, and it is foreseen that additional institutions will be connected in the later stages.
Built on top of the IHE XTB-WD (Cross-enterprise Tumor Board Workflow Definition) it streamlines the process to give the most of data governance possibilities and its value. The solution also embeds structured data sharing functionalities, discussion options and scheduling module. Application roles are carefully designed around each actor’s responsibilities in order to maximise efficiency and promptness.
In the first phase of the project, an out-of-cloud the solution supports urology tumor types and the MDO form that provides additional fields to enable a more in-depth structuring of the board discussions and recommendations.
UMC Utrecht Virtual Tumor board workflow
Professionals that are part of the MDO can have different roles and can choose between a range of specific workflows where the need for customisation is minimised. The patient data is available to be reviewed by the members at the moment the case is accepted and requires no further information or clarifications. Laboratory reports, patho-histology or any other document types can be accessed by all board members. When the case is concluded, a final, jointly accepted recommendation report is being created.
Integration profiles & Data Structures
The whole process is designed in a web-based and user-friendly manner with the goal of keeping every step of the process efficient and compliant to HL7® FHIR standard.
The solution is using the following IHE profiles:
- Cross Enterprise Workflow (XDW)
- Cross-Enterprise Tumor Board Workflow Definition (XTB-WD)
- Cross-Enterprise Document Sharing (XDS)
- Patient Identifier Cross-Referencing (PIX)
- Patient Demographics Query (PDQ)
Interoperability approach allowing equal access and secure & prompt document exchange
The solution is integrated with the regional Forcare Health Information Exchange (HIE) in order to provide a Cross-Enterprise Document Sharing (XDS) access and exchange of patient documents. It is expanded to partner’s hospital information systems via Cross Enterprise Workflow (IHE-XDW) profile.
Leveraging generally recognised and internationally accepted interoperability standards, the institutions are fully enabled to embrace the advantages on a technical and functional level. Successfully achieved integration with Forcare’s services in the existing affinity domain complements the functional perspective of the Multidisciplinary Team Meetings solution and support user experience on their path through the application. XDS and MPI (Master Patient Index) integration with Forcare’s forBridge and forIdex allows user to browse through patient’s existing documents in multiple affinity domains and enables the user to simply attach documents to an MDO. Achieving this, from the user perspective, it supports the MDO process going further in the most simplistic way possible (by adding new types of tumor boards and connecting to multiple institutions on a regional level).
The most crucial part of positioning the solution in the existing affinity domain, however, is not the above-mentioned integration, but the support of the IHE Cross Enterprise Document Workflow (XDW) profile. In the background of the user’s interaction with the solution, an XDW Document is created together with all other standardised documents per this profile. Not only does this enable full interoperability of MDOs between different organisations, different systems and different vendors, but also makes sure that access to patient’s documents is in-check with all existing affinity domain access control rules. The solution is therefore fully compliant with IHE interoperability standards and fully integrated into the existing affinity domain set up by Forcare.
Key outcomes
For care professionals
- Secure all-time access to urology board information from all 3 participant institutions leveraging the need of VPN connections and the usage of work stationaries;
- Possibility to prepare and discuss a case prior to the meeting for a more efficient and thorough case review in order to shorten the time of the MDO meetings and increase the quality of recommendations for patient’s future therapy;
- A streamlined process for minimising organisational overhead and planning due to a clear and structured workflow;
- Minimising manual efforts due to integration with regional XDS and other standard services;
- Facilitated remote participation to eliminate travelling costs and to stimulate attendance at MDOs;
- Pursuing interdisciplinary knowledge-sharing evenly across the region in the field of the complex urology cancer cases.
For patients
- Equal possibility of accessing the multi experts’ treatment recommendation within the region regardless of the location;
- Better care options due to faster knowledge and experience sharing.
A word from the customer
Gilbert Bod, IT Manager Strategic Alliances
UMC Utrecht
»In our hospital, we have the ambition to offer healthcare across the borders to give patients the best treatment options available. To be able to do so, we form tumor boards with other collaborative hospitals to discuss patient cases and regularly share knowledge. In the Netherlands, we have found very few software applications which could support our complex Tumor board processes and which could connect and integrate with the hospitals’ infrastructures such as XDS and AD. Within Vitaly, we have found everything we needed to accomplish our ambition.«
Interested in how Vitaly-supported Multidisciplinary Team Meetings can work in your multidisciplinary setting?
We’ll support you to match the solution configuration to your collaborative model.