Northern Netherlands region builds digital multidisciplinary consultation (MDC) platform with Workflower

In the Netherlands, oncology cases are discussed in regional MDCs that involve healthcare professionals from different hospitals. To support this complex process, an MDC platform has been set up in the Northern Netherlands using Workflower. A three-hospital pilot project has shown that Amaron’s process-automation solution can be used to set up an effective platform in a relatively short time—without requiring extensive development.

Complex challenge

The preparation and implementation of a regional MDC platform can often be time consuming:

• Specialists from the participating hospitals need to know which patients are on the MDC schedule.
• Before, during and after the MDC, participants must have access to the same patient data coming from the various electronic patient records (EPRs).
• The conclusions and agreements must be clearly recorded and comprehensible to all stakeholders.

A platform that supports the work process of these consultations and minimises data registration is indispensable. The national Citrien Regional Oncology Networks [Regionale Oncologienetwerken] programme, in which all Dutch university medical centres cooperate, therefore decided to develop three best practices for MDC support—if possible, using an existing, broadly applicable product.

Three regional networks have now carried out pilot projects, each with a different MDC platform. The Northern Netherlands region chose to build its platform with Amaron. Maarten de Ruiter, Project Leader at UMC Groningen and Digital Exchange Ambassador at the Regional Oncology Networks program, explains how this region set about the work.

Plan of requirements

“Initially, we drew up a plan of requirements for the MDC platform. Next, we searched a supplier. Amaron’s strong point was the broad applicability of the Workflower solution: we could use it to flesh out multi-site cooperation in a broader context. On the other hand, as a region, we wanted to take on most of the responsibility for the platform configuration and form design. This reduces the dependence on the supplier. That was a very important point in our decision to choose Amaron’s flexible solution.”

“As a first step, we described the process in detail, together with the users. This allowed Amaron to configure the solution very quickly; only a few iterations were needed to achieve the basic design of the process.”
Maarten de Ruiter, Project Leader at UMC Groningen
and Digital Exchange Ambassador at the Regional Oncology Networks program

Pilot project for a complex MDC process

After proof-of-concept validation, the region launched a pilot project for the Gynaecological Oncology MDC involving three hospitals: University Medical Centre Groningen (UMCG), Martini Hospital and Ommelander Hospital Groningen (OZG).

Broadly speaking, the process includes the following steps:

• OZG and Martini, can bring patients into the MDC. UMCG participates in the role of expert but does not include any patients.
• Within their own EPR, the secretarial staff from each hospital registers their patients to be discussed.
• The participating gynaecologists from OZG and Martini add any additional necessary data to their patients’ records.
• The medical secretary checks that everything is complete. The patient is then registered in the shared MDC platform (which has been configured with Workflower). At OZG, this is done manually. At Martini, it is done automatically using HL7 ORM messages. At the same time, the necessary medical and social history data, as well as the relevant test results (lab, medical imaging, etc.), are retrieved from the medical record (ChipSoft’s HiX) via a FHIR interface.
• The day before the MDC, the UMCG gynaecologist logs into the platform to review the list of patients to be discussed. She can look over each patient’s data, and make notes in the form. The patient is then assigned the status of ‘to be discussed’.
• During the MDC, the gynaecologist uses this list. The participating hospitals present their patients from their own EPRs, not from the MDC platform.
• The conclusions and treatment advice are recorded in the originating EPR for that patient. In the future, the goal is for this to be done centrally in the MDC platform, with the MDC report then being transferred to the EPR of the originating hospital.
• Currently, only the tumour type and treatment options, for example, radiotherapy or chemotherapy, are recorded in the platform This information is for informative purposes only.

Key benefits:

For the secretary:

• Thanks to the interface with the EPR, the secretarial staff at Martini no longer needs to generate a separate PDF and send it to UMCG via e-mail. They simply register the patient within their own EPR, and the relevant medical data is sent directly. If additional information becomes available after the patient has already been registered for the MDC, the platform automatically updates the patient data. Previously, they would send an additional e-mail.
• The administrative staff at UMCG no longer collect the data from OZG and Martini: in fact, they no longer have any tasks for the preparation of an MDC.
• The Gynaecology secretary at UMCG can see in the platform what has been agreed for the patient. If a patient is registered for a specialist MDC at UMCG, they can prepare the patient for the referral. Access to the platform has made this process run more smoothly, as well.

For the gynaecologists:

• The greatest advantage is for the gynaecologists at UMCG, who can consult all the patients in one place. They always have access to all the updated information, including the latest test results.

Statistics:

• The Project Team used the pilot to demonstrate that the statistics that can be generated deliver sufficient data to contribute to policy decisions.
• In addition, an anonymised export of the data entered can be created on the platform at any time.

Bilateral cooperation

The project was just getting started when the pandemic broke out. “We completed the whole pilot project—from the first meeting to the evaluation—remotely. It was only during the training, which took place in-person, that we spoke face-to-face with some of the Amaron people for the first time. That is something I think is very special about this project: We were able to complete a project like this even though we never actually met with one another,” continues Maarten de Ruiter.

“The setup of the interfaces at Martini was rather labour-intensive, and took place during the holiday period. Despite this, it was completed thanks to a great deal of dedication from both sides. By working hard together, we managed to finish it quickly. Amaron also always clearly indicated what could and could not be done. And everything that could be done got done. That is commendable.”

“We managed to get all the people involved in the process truly involved. They all loved working on this, and are proud of what has been achieved. The result? Our gynaecologists want to continue to work with Amaron’s MDC platform. It’s that simple.”

Good preparation pays

The greatest challenge in the process is to collect the right data at the hospital level when preparing a patient file for an MDC.

Maarten De Ruiter: “Martini had already put together a list of questions to collect the necessary information in the EPR. From Workflower, we can query this list using a FHIR interface, which allows the patient data to be transmitted automatically to the MDC platform. Martini started off on the right foot, which meant we could set up a successful project relatively quickly.”

“The hospital registers 10 to 15 patients per MDC. Previously, the preparation time was 10 to 30 minutes per patient. With the automatic data transfer, we save a lot of time.”

From pilot to general deployment

“It would be very convenient for the gynaecologists if all the MDCs, including those in Friesland or Drenthe, ran in the same way,” explains Maarten de Ruiter. “Uniform processes would make it easier for the doctors to take over MDCs from one another, for example. Our ambition is to get financing for this expansion, including for the interfaces with the various EPRs.  We need a business case to make it clear that the investment would pay off.”

“We would also like to use the platform widely for all oncology. In our region, the MDC processes for the different types of tumours are largely the same. At one point or another, a doctor says, ‘This patient needs to be discussed.’ Then a secretary prepares the patient registration, and the presenting doctor checks that all necessary data is included. The most important distinction in the MDC is in the registration form, the data set. But here, too, standardisation is becoming more prevalent on the national level.”

Currently, in the Netherlands, steps are being taken to standardise the registration from within the EPRs. The regional teams are working together in the national Regional Oncology Networks program where they can exchange knowledge about their projects.

“Ideally, we would like to see the registration process carried out in exactly the same way everywhere. Then, we only need to ask the EPR suppliers to set it up once. In the ideal scenario, we could even register a patient from our region on the Central Netherlands platform and vice versa.  In paediatric oncology, for example, there is a great deal of cooperation between Utrecht and Groningen,” says Maarten de Ruiter.

“For the MDCs outside of oncology, we could also use Workflower, and starting from a similar process. This is why we chose Amaron’s platform—it can support all disciplines and processes. This is what makes Workflower so interesting for us.”