Closing the Gap: Redesigning Data Capture to Support Both Clinical Operations and Outcomes Reporting

Abstract

Background As HSCT outcomes data reporting demand and case management documentation grows with patient volume and associated long term survival, transplant centers are seeking opportunities to improve the quality and more readily access the large variety of data available. A transplant and cell therapies workflow reengineering approach was developed at Dana-Farber Cancer Institute (DFCI) to leverage the functionality of a new combined case management and outcomes reporting system. While the workflow redesign impacts many disciplines in the program, special attention is drawn to a key workflow change that moves the outcomes data reporting team members from delayed retroactive reporting to contemporaneous data capture that supports both optimal CIBMTR outcomes repository reporting and case management during and throughout phases of care. The goal of this project was to leverage timely data capture to better inform optimal patient management as well as improve the quality of outcomes data collected. Methods A detailed current state work flow mapping process of the HSCT and cell therapies program was completed in 2017 to serve as a baseline during a series of workshops that engaged key stakeholders from all disciplines involved in patient care, coordination, and outcomes reporting to identify inefficiencies, workarounds, and pain-points. The workflows were organized into segments so that each can be modified using the SIPOR method (Suppliers, Input, Process, Output, Recipients). This framework enabled the creation of future state maps for implementation to enable staff to tap into functionality of the new consolidated data repository, outcomes reporting and case management application. Outcomes The future state design project using the SIPOR method enabled the production of highly detailed workflows that align effectively with software configuration. A special workshop series focused on the specific problem of moving CIBMTR and other outcomes data reporting into the case management stages of the overall workflow. This includes pre-treatment evaluation, donor or collection evaluation and donor selection, active treatment period and acute post-treatment information, and long term follow-up outcomes. The SIPOR method allowed the workshops to quickly achieve key program goals to ensure ready access to currently available patient progress information that optimizes patient coordination, eliminate multiple and late data reporting, provide access to readily available data for analytics alongside all other clinical data, and improve accuracy and quality of reported data. A key human factor improvement includes the melding of data reporting staff into the clinical and coordination teams that allowed for quick access to providers and others for learning and timely resolution of data problems.