Ordering Heart Transplantation

Miria Grisot

Dept. of Informatics

University of Oslo

TTeC2006 miriag@ifi.uio.no 2

Complexities

Complexity theme Information System research

Problem solving approach STS approach

Accepting complexity Information Infrastructure perspective

Use of IS in hospitals/healthcare systems Cross-disciplinary use of systems Patient process Support to coordination and information flow

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Heart transplantation

Slippery, elusive object balancing between:

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

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The process

Complex trajectory successfully coordinated No Transpl Unit Various disciplines:

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?

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Patient Trajectory

ReferralTransplant

SurgeryWaitingPeriod

Post-operativerecovery

EvaluationPeriod

Follow up

Acceptance to NH Match for Tx

Acceptance to WL

-DistrictHospital

-Cardiology-Tx Coord.-SpecializedExamination

-PeriodicalControls

-Toracic Surgery-HarvestingTeam-Tx Coord.

Data Production

-ICU-Cardiology

WL

-Cardiology

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Tx CoordinatorsCardiology Department

Patients, candidates, recipients, heart transplanted

Logistic and planning Controls and exams

Support before/after Information about the process and

consequences Nurses documentation (paper and electronic)

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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

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Transplant Surgeons Thoracic Surgery Department

Heart meeting Matching recipient/donor

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)

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Tx Coordinators Thoracic Surgery Department

Donor hospital Scandiatransplant (11 tr. hospitals)

database International Society for Heart and Lung

Transplantation (ISHLT) 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)

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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

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Hybrid Infrastructure in use transplant coordinator

nurses in cardiology transplant coordinator

nurses in surgery Surgeons Cardiologists immunologists patient coordinators lab technicians Bioengineers Pharmacologists Pathologists Microbiologists …

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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Cardiology department

Bed occupancy list

Admission Form

Plan for Blood analysis and tests

Modification on Waiting List

Institute for Immunology

Waiting List

Thoracic surgery department

Evaluation for Transplantation/HLA tests

ISHLT Recipient form

ISHLT Recipient follow up form

Heart waiting list member-form

Patient Record request

Archive Dep.

Room Booking

Patient Hotel

Heart Labs

Request for Angiography and other examinations

Institute forMicrobiology

Serology analysis of necrodonor

Microbiology report

Clinical Chemistry Dep

Analysis Request

Analysis Request

Analysis Request

Planning of evaluation

Intensive Care Form

Donor hospital

Organ Donation

Death Certificate

Donation Working form

Scandiatransplant Necro form

Transport form

Donation and Transpl. form

HeartCatetrization Results

Test Results

Echocardiography report

Biopsyreport

Information Checklist

HTx patient Plan

F1 form

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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)

Differences and co-existance Tight integration Loose integration

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Conclusions

How to accept complexity? From ”supporting coordination” to ”enacting

coordination” Incoherences and fragmentations can work

Information Infrastructures: Modes of ordering Connections and disconnections