Ordering Heart Transplantation Miria Grisot Dept of Informatics

Ordering Heart Transplantation Miria Grisot Dept. of Informatics University of Oslo TTe. C 2006 miriag@ifi. uio. no 1

Complexities n Complexity theme n Information System research n n Problem solving approach STS approach n Accepting complexity n Information Infrastructure perspective n Use of IS in hospitals/healthcare systems n n n TTe. C 2006 Cross-disciplinary use of systems Patient process Support to coordination and information flow miriag@ifi. uio. no 2

Heart transplantation n Slippery, elusive object n balancing between: n healthy enough/sick enough n matching recipient and donor n two trajectories: recipient and donor n chronic status: lifelong relation with the hospital/ implication for “amount” of information n different disciplines, different locations TTe. C 2006 miriag@ifi. uio. no 3

The process n Complex trajectory successfully coordinated n No Transpl Unit n Various disciplines: Cardiology, Thoracic Surgery, Immunology n Specilaised nurses: transplant coordinators n Lab technicians (service departments) n n Sharing of management duties and responsabilities n What are the complexity involved in terms of information production and use and how to ”picture” them? n How do they achieve unity without central control? TTe. C 2006 miriag@ifi. uio. no 4

Patient Trajectory Acceptance to WL Acceptance to NH Match for Tx Referral -District Hospital Evaluation Period Waiting Period -Cardiology -Tx Coord. -Specialized Examination -Periodical Controls Data Production TTe. C 2006 Transplant Post-operative Surgery recovery -Toracic Surgery -Harvesting Team -Tx Coord. Follow up -Cardiology -ICU -Cardiology WL miriag@ifi. uio. no 5

Tx Coordinators Cardiology Department n Patients, candidates, recipients, heart transplanted n Logistic and planning n Controls and exams n Support before/after n Information about the process and consequences n Nurses documentation (paper and electronic) TTe. C 2006 miriag@ifi. uio. no 6

Cardiologists Cardiology Department n Regular visits and controls before/after n Other options, irreversibility n Heart meeting n Service departments n Healthy enough, sick enough n Medications and side effects TTe. C 2006 miriag@ifi. uio. no 7

Transplant Surgeons Thoracic Surgery Department n Heart meeting n Matching recipient/donor n Waiting list n ABO, Body size/PVR, urgency, waiting time, CMV match, HLM match n Transplant surgery (5 hours) n Monitoring early rejections and infections (ICU) (3 -7 days) TTe. C 2006 miriag@ifi. uio. no 8

Tx Coordinators Thoracic Surgery Department n Donor hospital n Scandiatransplant (11 tr. hospitals) n database n International Society for Heart and Lung Transplantation (ISHLT) n n n 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) TTe. C 2006 miriag@ifi. uio. no 9

Immunologist and Lab technicians Institute for Immunology n Analysis of blood and serum n Microbiology n Blood bank n Pathology n HLA typing and screen for antibodies n Immunosuppressive treatment n Managing the waiting list n Scandiatransplant database n HLA lab/Nyrebase TTe. C 2006 miriag@ifi. uio. no 10

Hybrid Infrastructure in use n transplant coordinator nurses n n n in cardiology transplant coordinator nurses in surgery Surgeons Cardiologists immunologists patient coordinators lab technicians Bioengineers Pharmacologists Pathologists Microbiologists … TTe. C 2006 EPR/Portal Pims (adm) RIS EROS (lab) Nyrebase/HLA Lab Scandiatransplant Paper based patient record (centralised) n Local patient record at IMMI (recipient) n Local patient record at Th. S TCoo (donor) n. . . n n n n miriag@ifi. uio. no 11

Archive Dep. Institute for Immunology Patient Hotel Analysis Request Clinical Chemistry Dep Patient Record request Test Results Planning of evaluation Analysis Request Heart Labs Echocardiography report Biopsy report Heart. Catetrization Results Waiting List Cardiology department Heart waiting list F 1 form member-form Modification on Waiting List Room Booking HTx patient Plan Admission Form Information Checklist Evaluation for Bed Transplantation/HLA occupancy list tests Analysis Request for Plan for Blood Angiography and analysis and tests other examinations Serology analysis of necrodonor Microbiology report Institute for TTe. C 2006 Microbiology Scandiatransplant Intensive Care Form Necro form Transport form Donor hospital Organ Donation Working ISHLT Recipient form Donation and Transpl. ISHLT Recipient form follow up form miriag@ifi. uio. no 12 Thoracic surgery department Death Certificate

Ordering heart transplantation n Care Patient centered focus n Patient Identity n Action in the short term n Research n Focus on Organ/heart matching n Long term shaping of the process n Accounting n Focus on Professionals n Financial and legal aspects n Allocation and distribution (resources, time) n n Differences and co-existance Tight integration TTe. C 2006 n Loose integration n miriag@ifi. uio. no 13

Conclusions n How to accept complexity? n From ”supporting coordination” to ”enacting coordination” n Incoherences and fragmentations can work n Information Infrastructures: n Modes of ordering n Connections and disconnections TTe. C 2006 miriag@ifi. uio. no 14