Tracking Transplant Patients

By Debbie Gage  |  Posted 2008-01-30 Email Print this article Print
 
 
 
 
 
 
 

Integrating electronic systems that track organ transplants has been a challenge for most hospitals. But the Baltimoremedical center is refining a database that could serve as a model for the industry.

Through advances in science and medicine, organ transplanting has increased in frequency—and developed into an ever-growing business. At Johns  Hopkins Hospitalin Baltimore, surgeons are now performing nearly 400 transplant operations a year and are braced to handle even more to meet the increasing demand for organ replacement.

In 1996, Johns  Hopkins  Hospitalcombined its organ transplant programs into a single, comprehensive transplant center. The hospital wanted to manage all surgeries—liver, bone marrow, heart, lung, kidney, pancreas and cornea—through one system. One goal was to electronically follow patients from the time they were first referred to Johns Hopkins, through surgery and the following years of postoperative care. The idea was to improve communication between doctors and patients and eliminate redundant paper records, according to the center’s director at the time, Dr. Andrew Klein.

A dozen years later, the hospital is still working toward that goal. “There’s nothing magical about information systems,” says Bryan Barshick, the center’s decision support/transplant manager, who is in charge of the project. “It will give you the bedsheets but it won’t make the bed for you.”

As a May 2007 Baseline cover story on the transplant program at the Kaiser  Permanente San Francisco Medical Centerreveals, problems experienced in getting the IT piece of the operation right can have devastating consequences for patients. Kaiser opened its transplant center in 2004, but bungled paperwork and procedures, according to state and federal investigators. Kaiser shut down the facility less than two years after it opened.

While John Hopkins does not yet provide a text-book example of how to implement systems to manage a complex transplant center, it does offer other hospitals a guide to get closer to that goal.

No Room for Error

At John Hopkins, a big challenge has been getting staff and clinicians to abandon their comfort zone with paper-based processes in favor of automated transplant management systems. It’s not an uncommon problem for organizations adopting new technology. The transition is doubly challenging for John Hopkins and other top hospitals with zero tolerance for error in patient care and transplant compatibility. Mistakes can cost patients their lives.

All patients are listed in a national database administered by the United Network for Organ Sharing (UNOS), which matches organs with recipients based, in part, on how long they have been waiting for a transplant. UNOS uses complex algorithms to calculate that waiting time. It collects about 120 types of data and treats each type of organ tissue differently. Its database doesn’t automatically connect with the transplant databases at all hospitals, requiring some transplant centers to fax or e-mail patient data to UNOS.

The systems used to track patients and transplants tripped up Kaiser Permanente and, according to California regulators, placed patients “at risk for…potentially life-threatening delays in care.” Kaiser lost track of patients’ paper records, patients’ complaints and the time they spent on UNOS’ waiting list. Californiafined Kaiser Permanente $6 million.

Two years ago, Johns Hopkins replaced the transplant database it had been using, which it declines to name, with a more modern one from TeleResults, a database vendor based in San Francisco. Barshick has supervised the data cleansing—removing mistakes that had crept into the data over the years—and the redesign of clinical processes and retraining of staff. Some 175 members of the abdominal transplant team moved to the new software in June 2006. Other teams—thoracics, for instance—are using the new system, but not fully. “They were focused on paper-based tools,” Barshick says.

The hospital is building interfaces between the database and various in-house and third-party laboratories. Radiology will soon get an interface, and Barshick also will try exporting data electronically from TeleResults to UNOS.



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