| Questions on Oncology System and Tools |

Clinician's Frequently Asked Questions

How does my practice current workflows and document management policy / process get integrated in ICC Oncology CIS?

User workflow and management of documents is critical and ICC acknowledges this by working with your department and users to capture the current workflow. This ensures all necessary information is integrated accordingly into ICC Oncology CIS. Electronic chart note templates are created based on the workflow and document management policy/process. This permits the integration of all relevant information from administration to patient assessment, follow-up and treatment.

The ICC Oncology CIS is an expert electronic system that integrates information from a variety of traditional sources and presents it in a visual format so that it can be used effectively. ICC Oncology CIS transparently integrates the clinical workflow of physicians, nurses, and paramedical personnel while the modular construction of the system enables caregivers belonging to any medical speciality to practise their unique style of medicine.

How can our practice implement ICC Oncology CIS to our current IT infrastructure?

A full analysis of the client system is completed in cooperation with all appropriate client staff (e.g., IT and Administration). All necessary technical support is utilized in order to provide a thorough and detailed Implementation schedule. This begins with a detailed review of the existing IT infrastructure and an analysis of what is required in terms of hardware, software, and knowledge-base.

ICC Oncology CIS connects legacy systems, through our HL7 (engine interface) transaction manager, to the Clinical Data Repository (CDR). Information transfer is seamless and bi-directional. DICOM-enabled (engine interface), ICC Oncology CIS has the capacity to display medical imaging within the clinical context of the individual patient record and can also link with a client hospital PACS. As well, ICC Oncology CIS is deployed on a local area network in a “3-tier” configuration.

How long does it take to get our staff (medical, admin or technical) familiar with ICC Oncology CIS?

Hands-on training is implemented by ICC trainers and technical specialists, and customized to the requirements of each department (e.g., medical, admin, or technical).

ICC Oncology CIS’s intuitive, flexible interface obviates need for lengthy training phase for new users. All staff are trained efficiently with hands-on expert trainers by department group, specialty, and skill-level.

Training schedules are suited to the staff so as not to interrupt workflow. Training sessions involve small groups using video instructions alongside an expert trainer. Questions and Answers sessions are given at intervals, which are helpful with understanding detail features. Users are given hands-on practice during the training sessions with test cases for their specific group or specialty. Super-users are selected for their skills and are trained on the full system’s functionality in order to contribute and engender cooperation, which is found to accelerate the learning.

How can ICC Oncology Tools screens adapt to a clinical environment unique to each site?

Parametric components

ICC Oncology Tools screens are constructed using parametric components. There are a number of different ways that various clinicians may arrive at the same set of completed prescriptions because the same screens can often be configured to function along broadly different “parallel” lines of function. The most striking example of this parallelism lies in the existence of two broad methods of drug order entry. In one method, the clinician chooses the drug and drug “format” from a single list.

Multiple Drug Routing

In the alternative method, the clinician selects from a shorter list of drugs and chooses the drug format in a second step. The latter method, though seemingly adding an “unnecessary” second step to the order entry process, was built as a parametric addition to the system as it is most appropriate to the practice of oncology medicine. It was developed specifically at the request of a group of clinicians.

At a more granular level, ICC Oncology Tools screens are already “adapted” to the requirements of most sites that already have developed tried-and-true approaches to order entry and clinical charting. This is because most ICC Oncology Tools screens allow the clinician to prescribe and chart according to more than a single “allowed-method.” There is usually more than one route to accomplish a given order entry or charting task, and therefore it is highly likely that at least one existing ICC Oncology Tools method already corresponds to the order of work chosen by any individual clinician.

Without making any modifications to the system screens as they currently exist, a diversity of approach is already present. In the order entry activities screen, orders can be generated as a single entry or one at a time; administration times can be specified broadly or exactly; navigation can be alphabetical or “logical”; orders can be prescribed individually or may belong to ordersets.

Nurses workflow choices

In the nursing activities screen, nurses can review scheduled activities using an icon display or a tabular display; they can review the schedule for the entire care unit, for selected rooms belonging to the units or for selected nurses working on the unit. The nurse can chart his or her data entries through the activities screen or directly in the M.A.R., depending on which screen they feel more naturally reflects their personal approach to the clinical process. In results reporting, graphs can be navigated in “analog” mode or in “value” mode.

Modular clinical process

ICC Oncology Tools manages clinical processes as “modular”, i.e., as related to the individual specialties of medicine and surgery. Orders and procedures relevant to only certain specialties or sites may be displayed only at those wards, services or sites so that workflow documentation and order entry follow established local requirements.

ICC Oncology Tools is actually capable of maintaining individual, but inter-related, clinical information systems at each of the hospital, clinic or office sites belonging to a provider organization. Therefore, the navigation flow, the order types available, the drug listing and the test listing content, as well as all of the decision support rules related to each of these, may be tailored to individual sites. Additional screen development may be necessary to deal with clinical investigation or other very specific projects that would be unique to each organization or independent physician.

How does the ICC Oncology Tools clinical system ensure the delivery of the right medication to the right patient at the right time?

Safety first

The ICC Oncology Tools clinical information system ensures that the right medication is given to the right patient as follows:

 

 1.   The patient name, room and bed, hospital number, and the current date and time        are always displayed in the open order entry screen
 2.   Only one clinician may write prescriptions for a specific patient at the same time
 3.   All pending orders for a specific patient must be authorized (or cancelled) before        going on to write additional orders
 4.   The clinician may access the patient’s current M.A.R. during the order entry        exercise with one keystroke
 5.   The clinician may access the patient’s current clinical signs record during the order        entry exercise with one keystroke
 6.   The clinician verifies that the patient is not allergic to the specified drug or to any        drug in its pharmacological class
 7.   The clinician verifies that the same drug and dosage is not already prescribed
 8.   The physician is informed of any potential significant drug-drug interactions
 9.   The physician is informed of any recent laboratory results that contraindicate the        proposed prescription
10.  The clinician verifies that there is not an equivalently effective PO formulation of        an IV drug taking into account the appropriate diagnoses of exclusion and inclusion
11.  The clinician verifies that there are no sets of clinical conditions as defined by ICC Oncology Tools decision support that contraindicate the use of the proposed        medication
12.  ICC Oncology Tools’ decision support validates the upper and lower dose ranges, by        age
13.  ICC Oncology Tools’ decision support validates the dose routes
14.  ICC Oncology Tools’ decision support validates the dose administration frequencies        have been validated
15.  For pediatric prescriptions, the physician has the opportunity to review his or her        prescription in terms of both amount per dose and amount per day format
16.  For compound-dose prescriptions (i.e., mg/kg, etc.) the correct raw weight, ideal        body weight or dosing weight is used in the calculation, as appropriate
17.  The dosing schedule as prescribed by the physician is dynamically translated into        nursing timeline in the Medication Administration Record (M.A.R.) screen
18.  Internal ICC Oncology Tools Pharmacist decision support content is incorporated        into specific drug listings, as appropriate, and is seen by the prescribing physician at        order entry time
19.  Drugs determined to be appropriate for specific use at a site can be prescribed for        that specific use, and that alternative drugs appropriate to the context of a case, are        suggested by ICC Oncology Tools decision support, as appropriate
20.  All prescription content may be validated before administration through        bidirectional HL7 interface with the existing hospital pharmacy system
21.  Notification of scheduled upcoming drug administrations is displayed in three        separate screens available to the nursing staff – the M.A.R. screen, the Nursing        “pickup” screen and the Nursing Activity Scroll screen
22.  Notification of scheduled upcoming drug administration gives an adjustable warning        prior to the scheduled administration time (at least 30 mins.)
23.  The existence of pending late drug administrations is displayed in the notification        screens through the use of a specific icon
24.  When ICC Oncology Tools screens are accessed in wireless mode, medication        administration may be charted at the bedside using a computing tablet.
How is the ICC Oncology Tools clinician’s screens configured?

Flexible Configuration

The ICC Oncology Tools screens set may be navigated using a keyboard or a touch screen. Mouse may also be used. « Hotkey » navigation allows the clinician to rapidly access clinical functions documented by doctors and nurses, all of which are displayed in plain sight at all times. The screens are open and uncluttered. Drop-down menus are avoided. Doctors and nurses navigate an electronic interface which actually reflects clinical workflow as performed by the clinical staff.

Intuitive navigation made simple

Our unique graphical user interface (GUI) offers great simplicity of navigation for clinicians. It was conceived, developed and tested by leading practitioners and was used and amplified over many years in tertiary care medicine and surgery.

In our second-generation system, we have taken those features proven popular with physicians, nurses and pharmacists and incorporated them into an effective interface.

Each site may configure clinician screens so that patient names are entirely hidden until logon, while showing the presence of screen icons indicating the existence of certain critical clinical situations. It may also be configured to contain button controls giving access to non-system screens and/or Internet data sources.

Automatic signoffs prevent unauthorized access and patient data may be viewed only by secured digital access (biometric logon or the use of unique ID and password combination).

The principal physicians’ screen, displays the list of patients in a specific service or unit. The list can be explored by using the up and down arrow keys, the TAB key, or screen touch to move from column to column. At the top of the screen are located buttons that give access to other system clinical functions, including the ICC Oncology Tools electronic health record.

Rich clinical content

To the left of each patient’s name may be displayed one or more icons containing critical information relating to the appropriate patient. For instance, an icon may indicate that the specified patient has a positive microbiological culture for a body fluid and is not receiving appropriate antibiotic therapy; has at least one numerical laboratory test result outside of a defined normal (“alerts”) range; has at least one vital sign reading outside of a defined normal (“alerts”) range; that there is a message concerning the patient to the attention of his or her doctor, e.g., that the patient is in a state of dehydration or hypervolemia.

Biohazard warnings

There is also a biohazard icon that may be displayed indicating that though a culture is positive, the patient is already receiving appropriate antibiotic coverage. The message icon stores messages (e.g., text messages) from other system clinicians concerning the designated patient. The icon “content” is easily accessed directly from the screen where it is displayed. Additional icons are available, their use dictated by local site requirements.

Icons for instant notification

ICC Oncology Tools displays a number of icon images in the principal nursing screen that specify information unique to specific patients. Notification of the existence of pre-op or post-op orders written by a physician is given in this way, displaying the Pre-op or Post-op icon immediately to the left of the name of the designated patients, in the patient listing. Pre-op and post-op orders may be accessed through the appropriate icon directly from the screen in which it is displayed.

ICC Oncology Tools displays an icon to the left of the names of patients scheduled for blood tests. Upon opening the icon, the nurse or technician may then sign-off the blood drawing activity, with the date and time sent immediately via HL7 to the appropriate laboratory. The hemodialysis icon is displayed to the left of the names of the patients who are dialyzed and have drug orders associated with the dialysis schedule. The message and discharge icons available in the principal physicians’ screen are also available in the principal nursing screen.

Unique screens for the pharmacy and workflow coordinators also exist within two additional principal ICC Oncology Tools screens. Paramedical users access the system using one of the four existing principal screens.

Which ICC Oncology Tools modules and functions take advantage of portable wireless devices?

All ICC Oncology Tools modules and functions currently run in wireless environments using a computing tablet or a laptop. The tablet displays the full ICC Oncology Tools screens at 1024x768 resolution, and allows for the performance of all system functions. All entries are communicated in real-time to the system tables, and multi-directionally.

Can ICC Oncology Tools capture data for both clinical and research purposes?

Integrating Research Protocols

All numerical, text, and image data stored is available for review through the ICC Oncology Tools CIS. Clinical data, which was prescribed as part of a researcher’s protocol, are automatically forwarded to ICC Oncology Tools tables. Data required purely for research or protocol purposes may be defined for efficient capture through the use of the ICC Oncology Tools Protocol Data Administration screens. Initially developed for the ICC Oncology Tools, the flexible design of that screen allows its use to apply to any defined research protocol, including those outside the domain of oncology.

Reliable management of Clinical Trials

Because the ICC Oncology Tools Clinical Information System (CIS) allows for the ad hoc definition of clinical modules, a module may be defined for a clinician group or an independent single physician. With no special modification to the ICC Oncology Tools CIS, different clinical protocols may be maintained for individuals who are then defined through the Protocol Data Administration screens referred to above.

It is possible to customize the current table structure so that ICC Oncology Tools support your data privacy and security policy.

How can the ICC Oncology Tools Clinical Information System (CIS) support disease management programs?

A Tool For Infection Control

A disease management program can be defined as a grouping of multidisciplinary services targeted at patients with a specific family of disease(s). The ICC Oncology Tools CIS currently supports disease management programs through the incorporation of specialty-related ordersets and protocols. These may be easily modified, without coding, so that they apply to the reality of the patient population treated at the individual sites.

Ordersets and protocols may be designed to reflect practice at individual sites. Because the system makes use of its own internal data dictionary with corresponding terms in English, French and Spanish (or other character-based language), data collected at each site may be compared meaningfully with respect to outcomes analysis. Each protocol can also be identified with predetermined outcome targets.

Outcome Analysis

All CIS clinical data, including data captured in the patient chart and physician’s notes are coded and therefore also available for outcomes analysis. The ICC Oncology Tools CIS supports the implementation of disease management programs through the seamless integration of the documentation related to all clinical activities by all members (physicians, nurses, consultants, residents, and paramedical personnel) of the health care team.

Automated Clinical Reports

The CIS already contains a basic set of clinical reports that may be used as case-finding tools, identifying patients at risk for clinical deterioration or poor outcome. The longitudinal CIS patient record supports continuity of care, and in conjunction with ICC Oncology Tools Consent Management (included with the CIS Ambulatory Care functionality) gives staff at off-site locations access to a unified electronic health record.

The features of the proposed CIS that facilitates the implementation of a disease management program include the following:


 1.  Specialty-driven ordersets and protocols reflecting best practice at individual sites       with varied patient populations, integrated with M.A.R. and Care Plan
 2.  Target outcomes that may be linked to defined protocols
 3.  Built-in case-finding tools
 4.  Integration of the clinical process and of its documentation
 5.  Entirely coded clinical data entry by health care personnel
 6.  Longitudinal electronic health record
 7.  Consent Management allowing on and off-site access to all or part of a patient’s       electronic record
 8.  Audit capability for evaluation of clinical outcomes
How much "downtime" is normally required for backups, daily batch processing, and for minor and major upgrade installations?

Database backups - There is no downtime required to backup the database. A “hot” backup is performed every night on the ICC Oncology Tools database and the database is configured to operate in archive log mode.

Database batch processing - There are no database batch processes required in the application and therefore there is no downtime for database batch processing as the ICC Oncology Tools database is based on a relational model and was designed to maintain the functional needs of the application.

Database upgrade installations - A database upgrade is made up of two possible elements: 1) modifications to the database structure (e.g., table changes) and 2) the library management of the clinical reference information. During modifications to the database structure, clinicians should not be completing transactions on the database. The database upgrade installation requires a downtime of 10 minutes in order to apply the appropriate patches.

Remote monitoring

The library managed reference data upgrades are applied through the ICC Oncology Tools library management interface. Clinicians select clinical information from a dataset extracted from the ICC Oncology Tools master reference library, thereby including target data into their site-specific reference datasets. Since this process is performed through the system’s transaction-based interface, there is no downtime.

For a major upgrade of the application or the Relational Database Management System, a brief shutdown of the Production System is done off-peak (e.g. 4:30am) in order to bring the new version online. In this case, we switch to the standby database to minimize downtime. After the upgrade is done, the system is switched back to the production database, the standby node is updated, and the standby database is resynchronized.

During scheduled downtimes, if an upgrade change involves a structural change to the database, the ICC Oncology Tools system CIS will be brought down for a brief time during which the database object modifications are made.

If, during a scheduled downtime, a clinician experiences a disruption in access to the ICC Oncology Tools CIS he may resort to a Grid Independent Workstation for read-only access to all critical patient information.