DONORtrak system to streamline organ transplant process
A clinical information system designed to streamline the administrative and clinical processes associated with organ transplant is being evaluated by the Australian Government’s Organ and Tissue Donation and Transplantation Authority, alongside a number of internationally developed products.
The DONORtrak solution was developed by NEXVIEW Systems in collaboration with staff of the Flinders Medical Centre, with the intellectual property for the system now residing with the Commonwealth.
The development of DONORtrak commenced following a chance meeting at the Flinders Medical Centre in South Australia, where Catherine Hannan, an Organ and Tissue Donor Coordinator, became aware of a system operating in the Cardiac Echo Department that supported the remote display of echocardiogram images. As South Australia doesn’t have a heart/lung transplant unit, these organs, potentially suitable for transplant, are offered to hospitals in other states, including Queensland, New South Wales, Victoria and Western Australia. Having seen the applicability of the remote display of echocardiogram images to the current organ transplant process — and with a knowledge that hearts being offered from South Australia for transplant in other states had less chance of being accepted than hearts offered from within these states — a project to develop a clinical information system to support interstate organ transplant began.
Dr Gerry O’Callaghan, a senior consultant in intensive care medicine and the National Medical Director of the Organ and Tissue Donation and Transplantation Authority involved with the project, explains: “I was concerned that hearts were more likely to be accepted for transplantation if they were donated in the same state where there was a heart/lung transplantation program. One of the reasons we thought this might be the case is because its pretty difficult for the transplant physicians to have access to the information they might need to make a decision to transplant a heart into a recipient. It’s a very big decision to make and the process is very time critical.”
While the current version of DONORtrak has a more comprehensive feature set, the project initially focused on providing clinicians with access to images remotely.
“We felt that on balance, the quality of the information available to the people making the decisions was not of insufficient quality, but perhaps of insufficient detail. We started off the project to develop a system which had the capacity to transmit images so that the transplantation physicians and surgeons could look at the images themselves rather than having to rely on an interpretation from someone else,” explained Dr O’Callaghan.
The process for organ donation includes an Organ and Tissue Donor Coordinator spending a considerable amount of time populating a substantial paper‑based organ referral document with de-identified information contained within the deceased person’s medical record. The referral documents contain as many as 27 pages.
The Organ and Tissue Donor Coordinator then undertakes a process of offering the available organs to potential recipient healthcare organisations. This process involves the relaying of the information collected in the referral document to a recipient Transplant Coordinator by telephone. This information is subsequently conveyed to the recipient transplant surgeon, allowing them to make a determination regarding the suitability of the organ for transplant into one of their patients.
While fax machines have been utilised throughout the health sector for many years for the transmission of documents needing to be sent in a timely fashion, this method of communication is not deemed suitable for use in the organ transplant process to protect donor and recipient confidentiality. The fact that recipient donor coordinators may not be at their place of work when an organ becomes available has also ruled fax out as a viable method of communication.
With hearts and lungs only remaining suitable for implant for four and six hours respectively following retrieval from a deceased donor — and with such organs retrieved from South Australia needing to be transported long distances — improving the efficiency of administrative processes was seen as a high priority for the people collaborating on the DONORtrak system.
“When a decision is made to transplant a heart, there is only four hours to surgically retrieve the organ and transport it to, and subsequently transplant it into, a recipient. That’s not a lot of time in a country as big as Australia,” said Dr O’Callaghan.
With these time pressures in mind, the DONORtrak system’s feature set evolved, and now serves as an electronic replication of the paper‑based donor referral document.
Having entered the information into the electronic referral screen in DONORtrak, the donor coordinator is able to offer an organ via the system by simply selecting a recipient donor coordinator’s name and clicking a ‘send’ button. The recipient donor coordinator receives an SMS and an email, which contains a link to the DONORtrak website. After authenticating to the system, all details entered by the donor coordinator are visible, negating the need for the telephone transcription process to occur. With the information centralised in the DONORtrak system, multiple people involved in the process of the organ transfer can view the data simultaneously, which Dr O’Callaghan suggests will lead to improvements in the quality of care delivery.
“From the point of view of information sharing in health, systems that minimise the potential for data entry errors and can record and capture information that can be used in a reproducible and consistent way to analyse practice are really crucial to developing appropriate safety and quality standards,” said Dr O’Callaghan.
In addition to replicating the textual information found in the paper-based referral document, the electronic nature of the DONORtrak system has allowed the developers to provide additional functionality that paper-based workflows can not support. Images and video can be uploaded into the system, which typically include x-rays, echocardiogram videos, and high resolution photographs of extracted organs.
This additional functionality has already demonstrated the potential of such systems as Catherine Hannan describes: “A lung specialist who viewed our referral information electronically rang up and said ‘these lungs look quite wet, do you mind getting the ICU consultant to give some Lasix’, which is a drug to try and dry out the lungs. ‘I also see that you have an intravascular diagnostic catheter in this patient, can you do some pressure readings for us?’ All of a sudden they weren’t just getting the chest x-ray, they were actually understanding more about the way in which the donor was being managed in the intensive care unit, and were able to be involved in some of the clinical management of that donor to try and improve the lungs so that the transplant outcomes would be maximised.”
Posted in Australian eHealth