Bosserman Linda D, Lin YiHsuan, Shayani Sepideh, Moore Brian, Morse Denise, Enwere Emmanuel, Trisal Vijay, Samara Wafa
Department of Medical Oncology and Research Therapeutics, City of Hope, Duarte, CA 91010, USA.
Department of Pharmacy, City of Hope, Duarte, CA 91010, USA.
J Clin Med. 2025 Mar 17;14(6):2048. doi: 10.3390/jcm14062048.
Clinical decision support systems (CDSSs) consisting of Computerized Physician Order Entry (CPOE) and oncology pathways serve as the foundation of high-quality cancer care. However, the resources needed to develop and maintain these systems have not been characterized for oncology enterprises. Executive leadership appointed a medical director and clinical pharmacist to develop and lead a Pathways and Protocols Program for the City of Hope (COH) enterprise. This involved developing a program charter and governance committee and a business case for resources to support CPOE in our Epic Beacon treatment orders. Missing CPOEs for oncology treatments were identified for treatments in COH's Elsevier ClinicalPath treatment pathways and for those few diseases not in the pathways for medical oncology and hematology. New FDA oncology drug approvals were used to estimate ongoing CPOE build needs. Time estimates for Beacon analysts to build Beacon protocols were developed from a prior CPOE catch-up project, from informal surveys of our clinical pharmacists and Beacon leads, and surveys of staff leads at two other large, multisite cancer programs using Epic. Informal surveys of oncology clinicians and pharmacists were carried out to understand the time they were using to build Beacon orders that were not in the COH system. This information was used to build a business case for additional project management and staffing to catch up on building 400 missing Beacon orders, to maintain Beacon orders as new therapies and regimens are needed, and to provide required regulatory oversight of Beacon orders. Given these standards had not been shared by others, this work was gathered into a manuscript to help others evaluate and support needed resources to manage oncology pathway programs and CPOE to improve efficiencies, safety, and quality of care for medical oncology and hematology programs. A Pathways and Protocols program was developed with a governance committee, a program charter, and a charge for disease committees to prioritize, approve, and oversee the regulation of COH's Beacon treatment orders. CPOE resources to catch up and maintain COH's Beacon treatment orders were developed and shared with COH's executive leadership. Informal surveys were completed to benchmark Beacon resources with COH and two other Beacon enterprises as well as to estimate the time used by COH clinicians to build Beacon orders for orders not in the system. The resources for managing clinical oncology pathways and CPOE for an enterprise have not previously been published. Work components identified from our work at COH are shared so that other oncology leaders might have a starting framework to evaluate their own CDSS needs for oncology pathways and CPOE.
由计算机化医师医嘱录入系统（CPOE）和肿瘤学治疗路径组成的临床决策支持系统（CDSS）是高质量癌症护理的基础。然而，开发和维护这些系统所需的资源，对于肿瘤学企业来说尚未明确。行政领导任命了一位医学主任和一位临床药剂师，来为希望之城（COH）企业开发并领导一个治疗路径与协议项目。这包括制定项目章程、治理委员会以及一份关于支持我们在Epic Beacon治疗医嘱中使用CPOE所需资源的商业案例。针对COH的爱思唯尔临床路径治疗路径中的治疗以及医学肿瘤学和血液学路径中未涵盖的少数疾病，确定了肿瘤学治疗中缺失的CPOE。利用美国食品药品监督管理局（FDA）新批准的肿瘤学药物来估计持续的CPOE构建需求。Beacon分析师构建Beacon协议的时间估计，是基于之前的CPOE追赶项目、对我们临床药剂师和Beacon负责人的非正式调查，以及对另外两个使用Epic系统的大型多地点癌症项目的员工负责人的调查得出的。对肿瘤学临床医生和药剂师进行了非正式调查，以了解他们构建COH系统中未有的Beacon医嘱所花费的时间。这些信息被用于构建一个商业案例，以争取额外的项目管理和人员配置，来补上400条缺失的Beacon医嘱，在需要新的治疗方法和治疗方案时维护Beacon医嘱，并对Beacon医嘱进行所需的监管。鉴于这些标准此前未被其他人分享过，这项工作被整理成一篇手稿，以帮助其他人评估并支持管理肿瘤学治疗路径项目和CPOE所需的资源，从而提高医学肿瘤学和血液学项目的效率、安全性及护理质量。一个治疗路径与协议项目得以开发，包括一个治理委员会、一份项目章程，以及赋予疾病委员会的职责，以对COH的Beacon治疗医嘱进行优先级排序、批准并监督其管理。开发了用于补上并维护COH的Beacon治疗医嘱的CPOE资源，并与COH的行政领导进行了分享。完成了非正式调查，以便将COH的Beacon资源与另外两个Beacon企业进行基准对比，同时估计COH临床医生为系统中未有的医嘱构建Beacon医嘱所花费的时间。此前尚未公布过企业管理临床肿瘤学治疗路径和CPOE所需的资源。我们在COH的工作中确定的工作组成部分被分享出来，以便其他肿瘤学领导者可能有一个起始框架来评估他们自己对肿瘤学治疗路径和CPOE的CDSS需求。
