Ordering Heart Transplantation
Miria Grisot
Dept. of Informatics
University of Oslo
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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