OncoOrders: The Early Years

Abstract

This case study describes the development of an order-entry system in a chemotherapy clinic at Southwest Regional Medical Center. The system functions as a “whiteboard” and an organizational system for the Cancer Clinic. All of the systems were developed in-house at Southwest Regional by the Informatics Department. OrderAssistant, the order-entry system at Southwest Regional Hospital, has been in use in the wards for 7 years and has been a resounding success. A homegrown application, it was developed as an effort to supplant the cumbersome InVision system, which served previously as the computerized order-entry system at Southwest Regional. Although OrderAssistant is used in the inpatient environment, the designers felt that it could also be adapted to meet the Cancer Clinic outpatient’s needs such as tagging orders with DRG/ICD-9 codes and delivering orders to a patient who may or may not be located in a bed. Late in the course of the OncoOrders project, it was realized that the orchestration of activity that occurred after patients checked in resembled the activity in the Emergency Department (ED). In both environments, patients were triaged, checked in, and had labs, tests, and clinic visits scheduled according to their needs. The electronic whiteboard employed in the emergency room has been largely successful and has greatly increased the efficiency of workflow. Aiming to capitalize on that success, the Steering Committee decided to enlist help from the ED whiteboard team to produce a whiteboard for the infusion room in the chemotherapy clinic. This new whiteboard would provide an at-a-glance display of where each patient was and what treatment they were undergoing. It would also give the nurses relief from having to track patients via paper logs and retrieve each lab result via the electronic medical record. All of this information could be viewed on the whiteboard. Having decided upon what a digital Cancer Clinic would look like, the challenge remained to adapt these two tools for use in an outpatient clinic comprising patient visit, lab work, and chemotherapy infusion.