Every week, 2,633 Canadians are diagnosed with cancer. The subsequent chemotherapy treatments for those who need them require a toxic cocktail of drugs — so toxic, in fact, that any small mistake is potentially catastrophic.
This is where OPIS – a computerized physician order entry (CPOE) application
— comes in. Spearheaded by Cancer Care Ontario, which works with hospitals on information management systems to improve patient care and conduct research, the application was developed by clinicians for clinicians.
Recently, however, the CCO’s role changed from handling 38 per cent of the cancer treatment ordering in eight cancer centres to 100 per cent of it across the province. That meant OPIS needed a facelift.
“”It was designed as a standalone system that integrated with hospitals and provided data for our central database,”” says Dr. Brent Zanke, provincial head of systemic therapy at CCO and clinical advisor to the CPOE project. “”Now we’re dealing with 100 different hospitals that use chemotherapy and they all have their own information technology development strategies.””
A decade and a half ago, the advent of databases, fast processors and the declining cost of memory made electronic order entry a viable option. “”[CCO] did a survey of what was out there and found there really wasn’t an application that was acceptable for use in Ontario,”” says Zanke. So CCO took matters into its own hands. It needed something that would help deliver chemotherapy drugs more safely, while at the same time reduce the amount of work at the point of care. “”Unless an application does both of those things it isn’t useful because the physicians and pharmacists won’t accept an application that’s cumbersome and makes their already very long day longer,”” he says.
A process was undertaken with users — physicians, nurses and pharmacists — and its information technology developers to produce an application called OPIS, a physician order entry application for systemic therapy (made up of chemotherapy and non-chemotherapy drugs) to treat cancer patients. There were eight regional cancer centres using its existing application called OPIS 2000, covering 38 per cent of all systemic therapy orders in Ontario.
The chemo cocktail
“”The heart and soul of the application was its ability to order chemotherapy in a very flexible fashion. Chemotherapy is cumbersome and complex to order because it’s not usually single drugs that are ordered, but combinations of drugs that are given over a defined schedule that can stretch over six months,”” says Zanke. “”All of this can take an awful long time to order in the clinic because they’re not standard doses. It might take 10 minutes to order a complex chemo regimen.””
The application not only speeds up this process, but also intercepts errors in prescribing medication (paper-based order entry has many opportunities for error). It also helps to eliminate transcription errors due to the difficulty of interpreting handwriting. Electronic prompts warn against the possibility of drug interactions, allergies or overdose.
But as CCO’s role expanded to include responsibility for all cancer care in the province, it needed to make fundamental changes to OPIS. Zanke says CCO wanted to preserve all of the good things in the original application, such as ease of use and the ability to provide data on chemotherapy practice patterns, while providing the ability to integrate into a hospital system environment. The new version, OPIS 2005, will be piloted in a handful of sites early next year to test its ability to integrate with host systems.
The CPOE project will be rolled out in three phases. Phase 1 involves upgrading OPIS 2000 to OPIS 2005. “”We’re going to be implementing the OPIS 2005 system into three new cancer centers within the next year and then afterwards start upgrading all the sites to OPIS 2005,”” says Vincent Ng, senior project manager with CCO. “”The next site is Toronto’s Princess Margaret [Hospital] and once they get on board [along with] the other two hospitals, we should have about 50 per cent of all orders.”” Phase 1 will also involve upgrading to a more modern database: Oracle 9i.
Expanding the Web
In Phase 2, OPIS 2005 will be upgraded to a three-tier, Web-based architecture, called OPIS Web. This will be implemented in 10 OPIS sites and six sites that currently don’t use OPIS – increasing electronic orders to 64 per cent of all chemotherapy prescriptions. In Phase 3, OPIS Web will be rolled out to 15 new sites, increasing electronic orders to 90 per cent.
“”Once we get to OPIS Web, if we want to make changes to the system or create updates for the system we can upgrade all at once,”” he says. “”If we make changes to it now, every hospital has its own installation of OPIS so we have to make changes individually.””
Sam Marafioti, vice-president of e-health and chief technology officer at Sunnybrook and Women’s College Hospital in Toronto, says OPIS is an old application that served the cancer program well in the past. “”A new information management strategy was developed to really underscore that we are responsible for putting in place the appropriate clinical information systems to not only provide excellent care but, more importantly, provide the data [CCO] requires to fulfill their responsibilities,”” he says.