title: Analysis and classification of oncology activities on the way to workflow based single source documentation in clinical information systems.
abstract: BACKGROUND
  Today, 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Clinical 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.
authors.affiliation: Chair of Medical Informatics at the Friedrich-Alexander-University Erlangen-Nuremberg, Am Wetterkreuz 13, D-91058, Erlangen-Tennenlohe, Germany. stefan.wagner@fau.de.|Department of Anaesthesiology, University Hospital Erlangen, Krankenhausstraße 12, D-91054 Erlangen, Germany. stefan.wagner@fau.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagner
authors.affiliation: Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Östliche Stadtmauerstraße 30, D-91054 Erlangen, Germany.|Department of Obstetrics and Gynecology, University Hospital Erlangen, Universitätsstraße 21-23, D-91054, Erlangen, Germany.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Department of Urology, University Hospital Erlangen, Maximiliansplatz 2, D-91054, Erlangen, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Wullich
authors.affiliation: Medical Informatics and Communication Center, University Hospital Erlangen, Glückstraße 11, D-91054, Erlangen, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Seggewies
authors.affiliation: Department for Organizational Development, Klinikum Nuremberg, Prof.-Ernst-Nathan-Str. 1, D-90419, Nuremberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Ries
authors.affiliation: Institute for Medical Informatics I4MI, Bern University of Applied Sciences BFH, Höheweg 80, CH-2502, Biel/Bienne/Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bürkle
authors.affiliation: Chair of Medical Informatics at the Friedrich-Alexander-University Erlangen-Nuremberg, Am Wetterkreuz 13, D-91058, Erlangen-Tennenlohe, Germany.|Medical Informatics and Communication Center, University Hospital Erlangen, Glückstraße 11, D-91054, Erlangen, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Prokosch
mesh_terms: D004282:Documentation; D063005:Health Information Systems; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D057188:Workflow