Transcript Ordering Heart Transplantation

Ordering Heart
Transplantation
Miria Grisot
Dept. of Informatics
University of Oslo
Complexities
 Complexity theme
 Information System research
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Problem solving approach
STS approach
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Accepting complexity
 Information Infrastructure perspective
 Use of IS in hospitals/healthcare systems
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TTeC2006
Cross-disciplinary use of systems
Patient process
Support to coordination and information flow
[email protected]
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Heart transplantation
 Slippery, elusive object
 balancing between:
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healthy enough/sick enough
matching recipient and donor
 two trajectories: recipient and donor
 chronic status: lifelong relation with the
hospital/ implication for “amount” of
information
 different disciplines, different locations
TTeC2006
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The process
 Complex trajectory successfully coordinated
 No Transpl Unit
 Various disciplines:
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Cardiology, Thoracic Surgery, Immunology
Specilaised nurses: transplant coordinators
Lab technicians (service departments)
 Sharing of management duties and responsabilities
 What are the complexity involved in terms of information
production and use and how to ”picture” them?
 How do they achieve unity without central control?
TTeC2006
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Patient Trajectory
Acceptance to WL
Acceptance to NH
Match for Tx
Referral
-District
Hospital
Evaluation
Period
Waiting
Period
-Cardiology
-Tx Coord.
-Specialized
Examination
-Periodical
Controls
Data Production
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Transplant Post-operative
Surgery
recovery
-Toracic Surgery
-Harvesting
Team
-Tx Coord.
Follow up
-Cardiology
-ICU
-Cardiology
WL
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Tx Coordinators
Cardiology Department
 Patients, candidates, recipients, heart
transplanted
 Logistic and planning
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Controls and exams
 Support before/after
 Information about the process and
consequences
 Nurses documentation (paper and electronic)
TTeC2006
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Cardiologists
Cardiology Department
 Regular visits and controls before/after
 Other options, irreversibility
 Heart meeting
 Service departments
 Healthy enough, sick enough
 Medications and side effects
TTeC2006
[email protected]
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Transplant Surgeons
Thoracic Surgery Department
 Heart meeting
 Matching recipient/donor
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Waiting list
ABO, Body size/PVR, urgency, waiting time,
CMV match, HLM match
 Transplant surgery (5 hours)
 Monitoring early rejections and infections
(ICU) (3-7 days)
TTeC2006
[email protected]
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Tx Coordinators
Thoracic Surgery Department
 Donor hospital
 Scandiatransplant (11 tr. hospitals)
 database
 International Society for Heart and Lung
Transplantation (ISHLT)
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registry
Nordic Thoracic Transplant Study Group
Monitoring the patient-donor condition
Collecting donor information
Harvesting team (8-12 hours)
Travelling of recipients (4-5 hours)
TTeC2006
[email protected]
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Immunologist and Lab technicians
Institute for Immunology
 Analysis of blood and serum
 Microbiology
 Blood bank
 Pathology
 HLA typing and screen for antibodies
 Immunosuppressive treatment
 Managing the waiting list
 Scandiatransplant database
 HLA lab/Nyrebase
TTeC2006
[email protected]
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Hybrid Infrastructure in use
 transplant coordinator
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nurses in cardiology
transplant coordinator
nurses in surgery
Surgeons
Cardiologists
immunologists
patient coordinators
lab technicians
Bioengineers
Pharmacologists
Pathologists
Microbiologists
…
TTeC2006
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EPR/Portal
Pims (adm)
RIS
EROS (lab)
Nyrebase/HLA Lab
Scandiatransplant
Paper based patient record
(centralised)
 Local patient record at IMMI
(recipient)
 Local patient record at ThS
TCoo (donor)
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Archive Dep.
Institute
for Immunology
Patient Hotel
Analysis Request
Clinical Chemistry Dep
Patient Record
request
Test Results
Waiting List
Cardiology department
Planning of
evaluation
Heart waiting list
F1 form member-form Modification on
Waiting List
Analysis Request
Heart Labs
Echocardiography
report
Biopsy
report
HeartCatetrization
Results
Room Booking
HTx patient Plan
Admission Form
Information Checklist
Evaluation for
Bed
Transplantation/HLA
occupancy list
tests
Analysis Request
Request for
Plan for Blood
Angiography and
analysis and tests
other examinations
Serology analysis of
necrodonor
Microbiology report
Institute for
TTeC2006
Microbiology
Scandiatransplant
Intensive Care Form
Necro form
Transport form
Donor
hospital
Organ Donation
Donation Working
ISHLT Recipient
form
form
Donation and
ISHLT Recipient
Transpl. form
follow up form
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Thoracic surgery department
Death Certificate
Ordering heart transplantation
 Care
Patient centered focus
 Patient Identity
 Action in the short term
 Research
 Focus on Organ/heart matching
 Long term shaping of the process
 Accounting
 Focus on Professionals
 Financial and legal aspects
 Allocation and distribution (resources, time)
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 Differences and co-existance
Tight integration
TTeC2006
 Loose integration
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[email protected]
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Conclusions
 How to accept complexity?
 From ”supporting coordination” to ”enacting
coordination”
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Incoherences and fragmentations can work
 Information Infrastructures:
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TTeC2006
Modes of ordering
Connections and disconnections
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