ChipSoft internal project | March - July 2016

In previous versions of the developed EPR it proved difficult to plan complex care easily. Beside the planning it proved also difficult to reschedule all compontents of a treatment plan when one component was moved. Supporting healthcare professionals have to perform a lot of work to get everything in order when a change to the treatment plan is made. There is no permanent link between the separate components of a treatment plan.

A healthcare professional should be able to compose complex treatment plans in which every component is interconnected. Subsequent changes to the treatment plan can be easily made and easy rescheduling options for subsequent components of the treatment plan will be available.

All healthcare professionals who deal with complex treatment plans (like dialysis and oncology), can deploy a treatment plan within just one click. When loading the information about the patient (also known as the "hand shake") the status of the treatment plan is shown and can be easily adjusted. When a treatment plan is set, supporting healthcare professionals have planning options available for the selected patient.

A complete new module is created and tested if criteria and development goals are met. During testing several issues will be found. The issues will be discussed and may result in extra developments of the new module.

In future development patient transcending overviews will be created in order to create overviews for specific patient populations and monitor if (inter)national standards & criteria are met.

ChipSoft internal project | January 2016 till now

The majority of oncology patients receive multiple treatments over time. Those treatments are spread over several months or even years and patients can have several treatment plans. Treatment can consist of chemotherapy, radiation therapy, surgery, targeted therapy or immunotherapy. It is also possible that combinations of treatment options are persued. All this information is registered in the EPR, unfortunately the data can be scattered across the EPR and it is difficult to get a good overview about the oncology treatments received by the patient.

To create an overview of treatments received by an oncology patient what can be found at one place in the system. This can be accessed by all healthcare professionals who have to deal with oncology care.

The overview of oncology treatments can be found in all EPR's of healthcare professionals who deal with oncology care. All oncology related diagnoses are shown in this overview. A summary can be made per diagnosis which includes the TNM classification. Per diagnosis it is also possible to register a treatment plan and the healthcare professional also indicates the status of the treatment plan. In retrospect a letter can be generated and be sent to another healthcare professional outside the hospital.

To develop this feature it was necessary to set up two new forms, three new data retrieving overviews, a new graphical user interface to interact with the feature and three new elements for the word processing module of the EPR.

Future developments will focus on providing insight into multidisciplinary consultation and insight into treatments performed at the micro level, both on the level of a oncology diagnosis. It also shall be made possible to register a treatment plan directly from the standard patient contact form.

ChipSoft internal project | January 2016 till now

Diabetes nursus are key to inpatient care patients who suffer form diabetes or have diabetes as comorbidity. Unfortunately the patients can be hospitalised on every inpatient department. However the biggest issue is that diabetes is not always correctly registered as diagnosis or comorbidity. Diabetes nursus had to search the EPR for possible diabetes patients, because it is critical that their diabetes is critically monitored and treated.

Have one overview of inpatient care patients who suffer from diabetes or may suffer from diabetes; in combination with an overview of glucose levels, insuline medication and allergies.

After extensive discussions with several healthcare professionals of different hospitals about how to identify a inpatient care patient who suffer from diabetes or may suffer from diabetes, it was determined that a patient has to be monitored if one of more of the following applicable conditions: received diabetes medication, an abnormal glucose level is found during admission to the hospital or contact registrations regarding diabetes in the last year were found. The patient population is shown in one graphical user interface and diabetes nursus can indicate which patients were visited and even adjust diabetes medication prescriptions.

To develop this feature it was necessary to set up one new form, three new data retrieving overviews, a new graphical user interface to interact with the feature.

Another important quality of care indicator is that there is a history of peer consultation. At this moment this indicator can not be accessed by using this feature. Developments will be planned to incorporate this indicator.

St. Franciscus Vlietland Groep | December 2015 - November 2016

Implementation of the hospital-wide EPR. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. The work processes where defined and modelled using orders, thereby giving the hospital the possibility to use the EPR to communicate with other divisions within the hospital. Due to the fact this was an implementation of the hospital-wide EPR there were more discussions about hospital-wide processes, like the registration of the treatment limitations and MSRA / isolation procedures, donor registration, etc. Because this hospital had created their own EPR, discussions were held about the already existing features. Some of these features are included in the standard content of ChipSoft. After the acceptance tests the project was successfully completed.

ChipSoft internal project | August 2015

Every hospital does have an own registration form to register patient preferences about transition-to-end-of-life care. Every form is developed and because of the importance of patient preferences in this matter, the form can be registered and can be consulted practically everywhere in the EPR. Every access point has to be adjusted manually. This was a time consuming and prone to erros. Therefore another method of switching to the correct transition-to-end-of-life care form had to be developed.

To create an easy switch to set the correct transition-to-end-of-life care form in such a way that all access points directly refers to the correct transition-to-end-of-life care form.

Healthcare professionals will not notice the change; it is a change in the used methodology to retrieve the correct transition-to-end-of-life care form.

A switch was made by writing a complete new method and for the last time every access point code was rewritten in order to use the newly developed method. Beside this development a new empty transition-to-end-of-life care form was developed which can be adjusted by each hospital. One side note: the adjustments made by a hospital must adhere the established guidelines by ChipSoft.

At this moment no futher developments, regarding this feature, are planned.

Jeroen Bosch Ziekenhuis | August 2015 - June 2016

Again a project was launched to implement the EPR for the internal medicine department. Special attention is paid to the haematology and oncology department. During this project new content was developed for haematology, oncology and diabetes. Because of the extensive and long treatment patients receive, it was possible to lose track about which treatment is the active one and which are already persued.
Therefore overviews where created about oncological diagnoses. The oncologist has now the opportunity to summarise treatments and their status. The overview sorts the treatments chronologically over time.
Another problem that is solved is the lack of overview over patients who are hospitalised and using diabetes medication. An overview is created by using information of the hospital medication and it displays all hospitalised patients with diabetes medication.

ChipSoft internal project | April - June 2015

During the start of this project there was one contact form to register information during contact with a patient. The form was static and not every item was necessary to register. This resulted in extensive scrolling or tabbing and was not entirely user friendly. For example; during telephone consultations a short note will be registered about he course of the disease, healthcare professionals asked to show only one field and make the rest invisible.

Define per type of contact with the patient which field will be available in order to have a meaningful registration form which can be used during contact with a patient.

The healthcare professional characterises the contact with the patient. After characterisation by the healthcare professional, specific useful fields are available.

For each specialisation the registration form is adjusted with rules when which field will be available. A field will be visible if the criteria of characterisation by the healthcare professional and the visibility matrix are met.

Developments are focussing on user defined templates that can be used by each healthcare professional. ChipSoft will develop loads of building blocks and the healthcare professional can use those building blocks in their templates. Templates can be defined at the level of a specific disease, diagnosis or treatment.

Elkerliek | February - November 2015

Implementation of the EPR for the entire internal medicine division, including: internal medicine, diabetes, endocrinology, haematology, immunology, infectious diseases, renal diseases, oncology and vasculair medicine. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. The focus is on integrating the work processes to the best-practice EPR's of internal medicine. The work processes where defined and modelled using orders, thereby giving the internal medicine division the possibility to use the EPR to communicate with other divisions within the hospital. Special attention was given to diabetes and oncology day care. The planning of the chemotherapy treatments and cytostatics treatments were discussed. Also the process concerning the multidisciplinary consultation was intensively discussed and the content of the best-practice was improved. Although it was decided that one EPR is used for the entire internal medicine department, the outdoor departments are separated. Therefore a whole new way of filtering orders was developed, a specific outdoor department is noew able to filter its own orders.

VieCuri Medisch Centrum | January - June 2015

Implementation of the EPR for the oncology division. During this time we reviewed structured forms for the use of recording the contacts with the patients (is based on Oncoline), interactive questionnaires, correspondence and work processes. For both divisions extensive interactive questionnaires where developed like: EORTC QoL. Also it was required to have a possibility to register the condition of the patient with respect to chemotherapy treatments. The work processes where defined and modelled using orders, thereby giving the oncology division the possibility to use the EPR to communicate with other divisions within the hospital. The ordering to the laboratory is also implemented. During this project the pneumonologists would not like to co-operate with the oncology departement. After extensive discussion with the oncologists, they agreed to co-operate. After the acceptance tests the project was successfully completed.

Slingeland Ziekenhuis | August 2014 - February 2015

Implementation of the EPR for the entire internal medicine division, including: internal medicine, diabetes, endocrinology, haematology, immunology, infectious diseases, renal diseases and oncology. Special about this project was the fact that it was the first project in which it was decided to use one EPR, instead of one EPR per specialism, for the entire internal medicine department. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. The focus is on integrating the work processes to the best-practice EPR's of internal medicine. The work processes where defined and modelled using orders, thereby giving the internal medicine division the possibility to use the EPR to communicate with other divisions within the hospital.

Waterland Ziekenhuis | April - November 2014

Implementation of the hospital-wide EPR. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. The work processes where defined and modelled using orders, thereby giving the hospital the possibility to use the EPR to communicate with other divisions within the hospital. Due to the fact this was an implementation of the hospital-wide EPR there were more discussions about hospital-wide processes, like the registration of the treatment limitations and MSRA / isolation procedures. After the acceptance tests the project was successfully completed.

Lievensberg Ziekenhuis | February 2014 - December 2015

After successfully implemeting the oncology EPR a joint venture was started to innovate the oncology, cytostatics and day treatments as a whole. Due to the complex processes it is needed to continuously evaluate the best-practice and improve where appropriate. In the end it should be even a more integrated EPR suite, in which the EPR, cytostatics and day treatments are even better documented and easily accessible. The end user should see at a glance the treatment plan of the patient and see what's to come and see what has been done.

Franciscus Ziekenhuis | February 2014 - December 2015

After successfully implemeting the oncology EPR a joint venture was started to innovate the oncology, cytostatics and day treatments as a whole. Due to the complex processes it is needed to continuously evaluate the best-practice and improve where appropriate. In the end it should be even a more integrated EPR suite, in which the EPR, cytostatics and day treatments are even better documented and easily accessible. The end user should see at a glance the treatment plan of the patient and see what's to come and see what has been done.

Laurentius Ziekenhuis | November 2013 - February 2014

Implementation of the EPR for the oncology division. During this time we reviewed structured forms for the use of recording the contacts with the patients (is based on Oncoline), interactive questionnaires, correspondence and work processes. For both divisions extensive interactive questionnaires where developed like: EORTC QoL. Also it was required to have a possibility to register the condition of the patient with respect to chemotherapy treatments. The work processes where defined and modelled using orders, thereby giving the oncology division the possibility to use the EPR to communicate with other divisions within the hospital. The ordering to the laboratory is also implemented. After the acceptance tests the project was successfully completed

Rivas Zorggroep | September 2013 - April 2014

The hospital decided to implement a complete EPR suite and the internal medicine was one of the EPR's. During this implementation the focus on work processes and educate end users in how the use the best-practice EPR and give them tips and tricks. During the implementation of the internal medicine EPR, some forms were added for the vascular medicine. In this hospital the internal medicine is closely working together with the vascular medicine and in order to fully support work processes, this addition was needed.

Rivas Zorggroep | September 2013 - April 2014

The hospital decided to implement a complete EPR suite and the oncology was one of the EPR's. During this implementation the focus on work processes and educate end users in how the use the best-practice EPR and give them tips and tricks. During the implementation of the oncology EPR, the multidisciplinary consultation was discussed and forms and letters were created to fully support the work processes at the oncology department.

Lievensberg Ziekenhuis | January - October 2013

Just after one year re-implementing the hospital-wide EPR a new project was started to re-implement the hospital-wide EPR by using the newest version of our software. It was a joint venture of two hospitals. Because it was a new version and two hospitals using just one database. New features were introduced not only in lay-out but also in the software. Because of the new version many discussions were performed about general working and work processes. In the end the project was brought successfully live and still in use at this moment.

Franciscus Ziekenhuis | January - October 2013

The hospital-wide EPR was implemented by using the newest version of our software. It was a joint venture of two hospitals. Because it was a new version and two hospitals using just one database. New features were introduced not only in lay-out but also in the software. Because of the new version many discussions were performed about general working and work processes. In the end the project was brought successfully live and still in use at this moment.

Rijnstate | August - November 2012

After the hospital-wide EPR was implemented and a set of specialistic EPR's, oncology was one of the three last specialistic EPR's that was implemented. Within three review days on site, the best-practice oncology EPR was reviewed. Some adjustments were made to the TNM classification. The TNM classification is one of the most important classifications that describe the tumor. The best-practice TNM classification was enhanced. Work processes were reviewed in order that nothing was missed and every process was supported by the EPR.

Rijnstate | March - June 2012

After the hospital-wide EPR was implemented, haematology was one of many specialistic EPR's that was implemented. Within three review days on site, the best-practice haematology EPR was reviewed. No adjustments were made, only explaination was needed in how to use the EPR in everyday practice. Work processes were reviewed in other that nothing was missed and every process was supported by the EPR.

Lievensberg Ziekenhuis | January - May 2012

The hospital decided in 2011 to re-implement their hospital-wide EPR. During these months we reviewed the best-practice hospital-wide EPR and discussed about processes concerning the entire hospital. In all discussions the main topic was how to convert the current work processes en current forms to the new best-practice hospital-wide EPR. During this project there were some concerns about the implementation of the DHD and allergy module. The allergy module was put in use at the end of 2012.

Rijnstate | December 2011 - March 2012

The hospital decided in 2011 to re-implement their hospital-wide EPR. During these months we reviewed the best-practice hospital-wide EPR and discussed about processes concerning the entire hospital. In all discussions the main topic was how to convert the current work processes en current forms to the new best-practice hospital-wide EPR. This project was the basis for projects to follow in which all specialisms of the hospital got their own EPR which is build upon the hospital-wide EPR.

Rode Kruis Ziekenhuis | June - September 2011

On of the three hospitals that is specialized in treating burn wounds. During this implementation we reviewed the best-practice medical burn EPR. The latest interactive forms where evaluated and improved, like the lund-browder burn scale.

LUMC | January - July 2011

The String-of-Pearls initiative defined at that time eight pearls. The pearls represent a disease or disorder and the information stored is used for scientific research. The String-of-Pearls initiative is a joint venture of the eight university hospitals. During this project we integrated the dataset in our software and EPR's. The integration provided the possibility to extract the data automatically and provide it to the data center of the String-of-Pearls initiative.

Slingeland Ziekenhuis | October 2010 - April 2011

Implementation of the EPR for the nursing division. The implementation was executed for one specific department, the surgery department. During this time we reviewed structured forms for the use of recording the contacts with the patients during hospitalization, interactive questionnaires, correspondence and work processes. The work processes where defined and modelled using orders, thereby giving the nursing division the possibility to use the EPR to communicate with other divisions within the hospital. Because not all departments used the EPR it was necessary to discuss which tasks will be done using the EPR and which tasks will be done using paper or phone. Advices were given to the hospital. During this project there were some discussions about the national guidelines how to use a nursing EPR. It was decided to adjust the EPR of ChipSoft. After the acceptance tests the project was successfully completed.

Ziekenhuisgroep Twente | June - November 2010

Implementation of the hospital-wide EPR. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. The work processes where defined and modelled using orders, thereby giving the hospital the possibility to use the EPR to communicate with other divisions within the hospital. Due to the fact this was an implementation of the hospital-wide EPR there were more discussions about hospital-wide processes, like the registration of the treatment limitations and MSRA / isolation procedures. After the acceptance tests the project was successfully completed.

Maasstad Ziekenhuis | April - June 2010

Implementation of the EPR for the gastro-enterology division. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. The work processes where defined and modelled using orders, thereby giving the gastro-enterology division the possibility to use the EPR to communicate with other divisions within the hospital. After the acceptance tests the project was successfully completed.

VieCuri Medisch Centrum | April - September 2010

Implementation of the EPR for the nursing division. The implementation was executed for one specific department, the surgery department. During this time we reviewed structured forms for the use of recording the contacts with the patients during hospitalization, interactive questionnaires, correspondence and work processes. The work processes where defined and modelled using orders, thereby giving the nursing division the possibility to use the EPR to communicate with other divisions within the hospital. Because not all departments used the EPR it was necessary to discuss which tasks will be done using the EPR and which tasks will be done using paper or phone. Advices were given to the hospital. After the acceptance tests the project was successfully completed.

UMC Utrecht | March 2010 - May 2011

Implementation of the EPR for the haematology and immunology division. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. For both divisions extensive interactive questionnaires where developed like: EORTC QoL, EuroQoL 30, FLIPI and IPI. For the immunology division extensive questionnaires were developed to support processes with respect to transplantation. The work processes where defined and modelled using orders, thereby giving the haematology and immunology division the possibility to use the EPR to communicate with other divisions within the hospital. The ordering to the laboratory is also implemented. After the acceptance tests the project was successfully completed.

UMC Utrecht | March 2010 - May 2011

Implementation of the EPR for the oncology division. During this time we reviewed structured forms for the use of recording the contacts with the patients (is based on Oncoline), interactive questionnaires, correspondence and work processes. For both divisions extensive interactive questionnaires where developed like: EORTC QoL. Also it was required to have a possibility to register the condition of the patient with respect to chemotherapy treatments. The work processes where defined and modelled using orders, thereby giving the oncology division the possibility to use the EPR to communicate with other divisions within the hospital. The ordering to the laboratory is also implemented. After the acceptance tests the project was successfully completed.

LUMC | March 2010 - April 2011

Implementation of the EPR for the haematology and immunology division. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. For both divisions extensive interactive questionnaires where developed like: EORTC QoL, EuroQoL 30, FLIPI and IPI. For the immunology division extensive questionnaires were developed to support processes with respect to transplantation. The work processes where defined and modelled using orders, thereby giving the haematology and immunology division the possibility to use the EPR to communicate with other divisions within the hospital. The ordering to the laboratory is also implemented. After the acceptance tests the project was successfully completed.

LUMC | March 2010 - April 2011

Implementation of the EPR for the oncology division. During this time we reviewed structured forms for the use of recording the contacts with the patients (is based on Oncoline), interactive questionnaires, correspondence and work processes. For both divisions extensive interactive questionnaires where developed like: EORTC QoL. Also it was required to have a possibility to register the condition of the patient with respect to chemotherapy treatments. The work processes where defined and modelled using orders, thereby giving the oncology division the possibility to use the EPR to communicate with other divisions within the hospital. The ordering to the laboratory is also implemented. After the acceptance tests the project was successfully completed.

Maasstad Ziekenhuis | February - April 2010

Implementation of the EPR for the orthopaedics division. During this time we reviewed structured forms for the use of recording the contacts with the patients, interactive questionnaires, correspondence and work processes. The work processes where defined and modelled using orders, thereby giving the orthopaedics division the possibility to use the EPR to communicate with other divisions within the hospital. After the acceptance tests the project was successfully completed.