Addressing critical issues in the development of an Oncology Information System

Increasing Annual Cancer Incidence in Patients Age 20-49 Years: A Real-Data Study

PURPOSE

Data from population-based studies have shown an increased incidence of certain types of neoplasms in patients younger than 50 years (early-onset cancer [EOC]); however, little information is derived from other real-world data sources. In a nonpopulation registry, we analyzed changes in the incidence of several neoplasms in successive generations.

METHODS

This cross-sectional study included all patients with a cancer diagnosis registered in one university hospital in Málaga, Spain, between 1998 and 2021, and 18 neoplasms were analyzed. For each neoplasm, the proportion of patients younger than 50 years and age 50 years and older (late-onset cancer [LOC]) of the total number of patients diagnosed each year was determined. In addition, the age limit was lowered to 45-40 years. Changes in these proportions between each year and the following year were assessed by calculating the annual percentage change (APC), and a final assessment of these changes was performed by determining the average APC (AAPC).

RESULTS

Of the 24,596 patients, 5,466 (22.2%) had EOC, and 19,130 (77.8%) had LOC. The incidence of all tumors increased throughout the study period in both age groups. The AAPC increase was higher in patients with EOC than in those with LOC for the following neoplasms: head and neck (6.1% v 4.6%), colon (11.0% v 8.2%), testicular (16.3% v -13.1%), non-Hodgkin lymphoma (8.4% v 5.9%), rectum (16.1% v 6.8%), kidney (27.8% v 20.1%), and sarcoma (43.4% v 28.6%). This increase was confirmed in patients younger than 45 years and 40 years.

CONCLUSION

Our results are consistent with the data published for most tumor sites analyzed. This global public health problem requires the utmost attention to decrease excess cancer in young patients.

Significant Decrease in Annual Cancer Diagnoses in Spain during the COVID-19 Pandemic: A Real-Data Study

The COVID-19 pandemic has caused a profound change in health organizations at both the primary and hospital care levels. This cross-sectional study aims to investigate the impact of the COVID-19 pandemic in the annual rate of new cancer diagnosis in two university-affiliated hospitals. This study includes all the patients with a pathological diagnosis of cancer attended in two hospitals in Málaga (Spain) during the first year of pandemic. This study population was compared with the patients diagnosed during the previous year 2019. To analyze whether the possible differences in the annual rate of diagnoses were due to the pandemic or to other causes, the patients diagnosed during 2018 and 2017 were also compared. There were 2340 new cancer diagnosis compared to 2825 patients in 2019 which represented a decrease of -17.2% (p = 0.0001). Differences in the number of cancer patients diagnosed between 2018 and 2019 (2840 new cases; 0.5% increase) or 2017 and 2019 (2909 new cases; 3% increase) were not statistically significant. The highest number of patients lost from diagnosis in 2020 was in breast cancer (-26.1%), colorectal neoplasms (-16.9%), and head and neck tumors (-19.8%). The study of incidence rates throughout the first year of the COVID-19 pandemic shows that the diagnosis of new cancer patients has been significantly impaired. Health systems must take the necessary measures to restore pre-pandemic diagnostic procedures and to recover lost patients who have not been diagnosed.

A Conceptual Model of an Oncology Information System

Introduction

Oncologists are usually faced with a huge amount of diagnostic and therapeutic data in the process of cancer care. However, they do not have access to the integrated data. This research aimed to present a conceptual model of an oncology information system based on the users' requirements.

Methods

This study was conducted in 2019 and composed of two phases. Initially, a questionnaire was designed, and clinical experts (n=34) were asked to identify the most important data elements and functional requirements in an oncology information system. In the second phase, conceptual, structural and behavioral diagrams of the system were drawn based on the results of the first phase. These diagrams were also reviewed and validated by five experts.

Results

Most of the data elements and all functional requirements were found important by the experts. The data elements were related to different phases of cancer care including screening, prevention, diagnosis, treatment, mental care and pain relief, and end-of-life care. Then, conceptual, structural and behavioral diagrams of the system were designed and approved by the experts or revised based on their comments.

Conclusion

The conceptual model and the diagrams presented in the current study can be used for developing an oncology information system. This system will be able to manage patients' cancer data from screening to the end-of-life care. However, the system needs to be designed and implemented in a real healthcare setting to see how it can meet users' requirements.

Factors Influencing the Adoption of Online Health Consultation Services: The Role of Subjective Norm, Trust, Perceived Benefit, and Offline Habit

The cyberspace plays an important role in improving the quality, equity, and efficiency of health services. Studying people's adoption of online health services, such as online health consultation services (OHCS) can benefit both industry and policy in the health service sector. This paper investigates influencing factors and paths of people's intention of adopting OHCS by employing the extended valence framework, with our new contribution of integrating subjective norm and offline habit into the model. Five hundred forty-three university students participated in the survey. Structural equation models and Sobel-Goodman tests were applied to test the models. The results show that subjective norm (β = 0.077, p = 0.041), trust in providers (β = 0.194, p = 0.002) and perceived benefit (β = 0.463, p < 0.001) positively affect the intention to adopt OHCS, while offline habit (β = -0.111, p = 0.026) has a negative effect. However, the association of perceived risk (β = -0.062, p = 0.315) and adoption is not supported. Moreover, trust in providers plays a mediating role between subjective norm and the intention of adopting, while perceived benefit mediates the relationship between trust in providers and the intention of adopting. This study highlights the importance of trust, subjective norm, perceived benefit, and persisting habits in promoting the adoption of OHCS.

Oncology Information System: A Qualitative Study of Users' Requirements

Background:

Cancer care is a complex care process and is associated with generating a variety of data during the care process. Therefore, it seems that designing and using information systems is necessary to enhance the accessibility, organization and management of cancer-related data. The aim of this study was to identify users’ requirements of an oncology information system (OIS).

Methods:

This was a qualitative study conducted in 2018. In depth semi-structured interviews were performed with clinicians and non-clinicians in five teaching hospitals to identify users’ requirements. Data were analyzed by using framework analysis.

Results:

The four themes emerged from data analysis included: a) methods of recording cancer data in the hospitals, b) required cancer data in different departments, c) comprehensive cancer care documentation, and d) required functions of an oncology information system.

Conclusion:

According to the results, currently, electronic documentation is less frequently used for cancer patients. Therefore, an extensive effort is needed to identify users’ requirements before designing and implementing an oncology information system. As multidisciplinary teams are involved in cancer care, all potential users and their requirements should be taken into account. Such a system can help to collect and use cancer data effectively.

Consensus Recommendations for Developing IQ Script Enabled Radiation Oncology Care Plans in the MOSAIQ Oncology Information System

BACKGROUND

IQ script enabled radiation oncology (RO) Care Plans are a unique functionality of the MOSAIQ oncology information system and enables standardization of clinical workflow via predefined order sets, strategic launching of assessment forms, and automated forwarding of clinical tasks. However, the development of RO Care Plans is center-specific and must be adapted to each center's clinical workflow. To our knowledge, little to no guidelines exist for RO Care Plan implementation. This article is a collaborative article from 5 different centers of varying sizes and adoption stage that provides consensus strategies for RO Care Plan development.

METHODS

In 2016, 5 different centers of varying sizes and adoption stages met to develop strategies for RO Care Plan development. Before the meeting, an initial draft was circulated to all participating centers for feedback and incorporated into a refined document. The refined recommendations underwent a formal, 3-stage consensus process mediated by a radiation therapist to arrive at the final document.

RESULTS

Overall, 17 recommendations were provided that focused on 7 areas of Care Plan development: (1) predevelopment planning, (2) current-state RO workflow evaluation, (3) future-state RO integration planning, (4) Care Plan authoring, (5) pre-implementation, (6) implementation, and (7) post-implementation evaluation and review.

CONCLUSIONS

Care Plan development is a center-specific process, and the resulting recommendations provide a blueprint for a broad range of cancer centers for implementing Care Plans, or similar oncology information system modules, into their clinical processes.

Human-centered design of a personal health record system for metabolic syndrome management based on the ISO 9241-210:2010 standard

Background

Previous studies have demonstrated the effectiveness of information and communication technologies to support healthy lifestyle interventions. In particular, personal health record systems (PHR-Ss) empower self-care, essential to support lifestyle changes. Approaches such as the user-centered design (UCD), which is already a standard within the software industry (ISO 9241-210:2010), provide specifications and guidelines to guarantee user acceptance and quality of eHealth systems. However, no single PHR-S for metabolic syndrome (MS) developed following the recommendations of the ISO 9241-210:2010 specification has been found in the literature.

Objective

The aim of this study was to describe the development of a PHR-S for the management of MS according to the principles and recommendations of the ISO 9241-210 standard.

Methods

The proposed PHR-S was developed using a formal software development process which, in addition to the traditional activities of any software process, included the principles and recommendations of the ISO 9241-210 standard. To gather user information, a survey sample of 1,187 individuals, eight interviews, and a focus group with seven people were performed. Throughout five iterations, three prototypes were built. Potential users of each system evaluated each prototype. The quality attributes of efficiency, effectiveness, and user satisfaction were assessed using metrics defined in the ISO/IEC 25022 standard.

Results

The following results were obtained: 1) a technology profile from 1,187 individuals at risk for MS from the city of Popayan, Colombia, identifying that 75.2% of the people use the Internet and 51% had a smartphone; 2) a PHR-S to manage MS developed (the PHR-S has the following five main functionalities: record the five MS risk factors, share these measures with health care professionals, and three educational modules on nutrition, stress management, and a physical activity); and 3) usability tests on each prototype obtaining the following results: 100% effectiveness, 100% efficiency, and 84.2 points in the system usability scale.

Conclusion

The software development methodology used was based on the ISO 9241-210 standard, which allowed the development team to maintain a focus on user’s needs and requirements throughout the project, which resulted in an increased satisfaction and acceptance of the system. Additionally, the establishment of a multidisciplinary team allowed the application of considerations not only from the disciplines of software engineering and health sciences but also from other disciplines such as graphical design and media communication. Finally, usability testing allowed the observation of flaws in the designs, which helped to improve the solution.

An appraisal of published usability evaluations of electronic health records via systematic review

OBJECTIVE

In this systematic review, we aimed to evaluate methodological and reporting trends present in the current literature by investigating published usability studies of electronic health records (EHRs).

METHODS

A literature search was conducted for articles published through January 2015 using MEDLINE (Ovid), EMBASE, Scopus, and Web of Science, supplemented by citation and reference list reviews. Studies were included if they tested the usability of hospital and clinic EHR systems in the inpatient, outpatient, emergency department, or operating room setting.

RESULTS

A total of 4848 references were identified for title and abstract screening. Full text screening was performed for 197 articles, with 120 meeting the criteria for study inclusion.

CONCLUSION

A review of the literature demonstrates a paucity of quality published studies describing scientifically valid and reproducible usability evaluations at various stages of EHR system development. A lack of formal and standardized reporting of EHR usability evaluation results is a major contributor to this knowledge gap, and efforts to improve this deficiency will be one step of moving the field of usability engineering forward.

Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases

RATIONALE, AIMS AND OBJECTIVES

Complex chronic diseases are a challenge for the current configuration of health services. Case management is a service frequently provided for people with chronic conditions, and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers and services used.

METHODS

The study was divided into three phases, covering the detection of information needs, the design and its implementation in the health care system, using literature review and expert consensus methods to select variables that would be included in the registry.

RESULTS

A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. A web-based registry with modular and layered architecture was designed. The framework follows a pattern based on the model-view-controller approach. In its first 6 months after the implementation, 102 case managers have introduced an average number of 6.49 patients each one.

CONCLUSIONS

The registry permits a complete and in-depth analysis of the characteristics of the patients who receive case management, the interventions delivered and some major outcomes as mortality, readmissions or adverse events.

An automatic tool to facilitate the statistical group analysis of DTI

BACKGROUND

Users may have difficulty calculating DTI group statistics since they need to master several complex tools that require high user intervention. A tool called DTIStatistics for the automatic and easy calculation of DTI group statistics was developed to reduce analysis times and possible errors.

METHODS

The proposed software was designed by using a user-centred methodology in which we performed an iterative usability evaluation with an expert committee. Once the experts׳ requirements were fulfilled, we performed a validation of the final version of DTIStatistics with target users, comparing the execution time of this tool and the standard pipeline normally used.

RESULTS

Target users needed significantly less time to complete the tasks with DTIStatistics, reducing the analysis time from 1383.78 to 57.2s. They were able to complete all the tasks and barely made errors. Moreover, target users were not able to display the analysis results with the standard pipeline, but when using our tool they only needed 34s. Target users found DTIStatistics easy to learn, use and interact with, and they concluded that they could effectively complete the tasks with it. Additionally, we present example results in the study of depression to demonstrate the validity of DTIStatistics for clinical research.

CONCLUSIONS

DTIStatistics facilitates and significantly automates the calculation of DTI group statistics by reducing the analysis times, which implies lower costs. DTIStatistics is highly applicable in clinical research, as demonstrated by the fact that it is currently being used at the University Hospital, University of Navarra (Spain).