Improving chemotherapy processes with a protocol-based information system: A pre and post-implementation study

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 postimplementation
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 preimplementation
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).