title: Improving chemotherapy processes with a protocol-based information system: a pre and post-implementation study.
abstract: BACKGROUND
  The medical application domain has been a great challenge for information technology solutions for decades, especially when the target process has been complex and multidisciplinary such as chemotherapy processes.
  
  
  OBJECTIVE
  To evaluate the impact of a homegrown protocol based information system on the efficiency of chemotherapy workflow processes in an outpatient setting.
  
  
  METHODS
  A day care unit of the Hematology/Oncology outpatient clinic of Erasmus Medical Center was the setting for this study. The study consisted of comparison of pre- and post-implementation of four workflow efficiency related external indicators: turn-around times of a commonly administered chemotherapy course (Paclitaxel-Carboplatin), chemotherapy course administration postponing rate, the rate of recording course administration time, and patient admission rate of the outpatient clinic. The data was gathered retrospectively from patient charts and information systems' log files. For the purpose of turn-around-time 109 Paclitaxel-Carboplatin chemotherapy courses of pre-implementation were compared to 118 those of post-implementation. For the other indicators: 247 chemotherapy courses pre-implementation were compared to 324 courses post-implementation. The process maps of pre- and post-implementation were also compared to each other.
  
  
  RESULTS
  The implementation of the system improved the process by removing repetition and sequencing of the tasks. Following the implementation, chemotherapy postponing decreased by 17.2% (Z = -4.723, P = .000) and there were 5.7% less records with missing administration time (Z =-3.047, P = .002). The admission rate increased 1.9 patient per working day (t(94) = -5.974, P = .000). The overall turn-around-time reduced 18.9 min following the implementation (t(169) = 3.48, P = .001). In a multivariate multiple regression model the reduction in turn-around time was related to the implementation of the system (Pillai's Trace = 0.159, F(4,161) = 7.613, P = .000).
  
  
  CONCLUSIONS
  Information systems based on treatment protocols can reduce communication and synchronization needs between the stakeholders in a complex workflow process. These systems can help reengineering the process and improve workflow efficiency by removing unnecessary sequencing and repetitions of tasks.
authors.affiliation: Medical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran. pirnejad@bmg.eur.nl
authors.forename: Habibollah
authors.initials: H
authors.lastname: Pirnejad
authors.forename: Chen
authors.initials: C
authors.lastname: Gao
authors.forename: Roel
authors.initials: R
authors.lastname: Reddingius
authors.forename: Anita
authors.initials: A
authors.lastname: Rijneveld
authors.forename: Roland
authors.initials: R
authors.lastname: Bal
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D006801:Humans; D007256:Information Systems; D009369:Neoplasms / Q000188:drug therapy*; D010343:Patient Admission; D011787:Quality of Health Care
chemical_list: D000970:Antineoplastic Agents