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BIDMC’s chemotherapy prescription program adds new safety features, efficiency

A new computerized system for chemotherapy patients promises to advance Beth Israel Deaconess Medical Center’s patient safety effort by establishing automatic standards for all treatment plans.

BOSTON - A new computerized system for chemotherapy patients promises to advance Beth Israel Deaconess Medical Center's patient safety effort by establishing automatic standards for all treatment plans.

"This is a major milestone," said Larry Markson, MD, Director of Development, Information Systems, in discussing the addition of oncology to the medical center's computerized physician order entry (POE) system. "This adds quite a significant number of new safety features and benefits. The dosing calculations are automatic and the regimens are standardized."

Most chemotherapy today is delivered on an outpatient basis, where the patient comes in for what can be many hours of treatment that includes not just the chemotherapy itself, but also a host of other medications, fluids and supportive therapies.

"What this system lets you do is go to a tab in [web-based online medical records] and see the complete history of doctor's orders," said Markson. "The patient's oncology tab has a detailed history of everything ordered, when it was ordered, and what happened. Did the therapy treatment get delivered as ordered? Was it held? Was it partly delivered? Did the patient have an adverse reaction? That in itself, all online, is a big safety feature."

Another important feature is that the system alerts the physician if an entry is made outside of the usual or standard range.

"The system will send an alert that this is a change from the usual," said Markson. "We know that physicians will sometimes intentionally and appropriately order therapy that is outside the usual range. The idea behind alerts is to catch people from making mistakes unintentionally."

Side by side with the chemotherapy orders, the system also displays all relevant labs and allows the physician, nurses, pharmacists and other health care workers to follow the patient through his or her workflow, from arrival, to looking at their vital statistics, when treatment occurs and if there were any adverse reactions.

"We've created a level of integration that you just don't see anywhere else," said Markson.

Unlike other treatments where a physician writes an order and that order continues until it is dismissed, oncology requires writing a lot of future orders, but they may not be the same each day over the course of a month's time. "There's really nothing else quite like this for varying orders at different points in time," said Markson. "The benefits of this new system are going to be enormous, both in terms of safety and efficiency."

Writing software that could take all this into account and also adapt to constant changes and updates was no easy task, said Jean Hurley, POE Development Manager. "The most challenging aspect of the project was to define the complex clinical workflows and technical rule sets that are required to implement a safe and effective system," said Hurley.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.harvard.edu.