Updated: Feb 1, 97
PROCAS

Project Code:   A2030 Project value:   1395 KECU EC contribution:   698 KECU No of partners:   5 No of countries:   5 Duration:   36 months

Contact: Dr. Paolo Di Loreto c/o Istituto San Raffaele Via E. Chianesi, 33 I-00124 Roma, Italy Tel.: +39-6-52.40.52.01 Fax: +39-6-52.40.52.13

Overview

PROCAS identified two medical domains on which to focus and test the conceptual model suggested, that is cancers and cardiovascular diseases (they were chosen for their incidence in the European countries).

Purposes, goals and objectives

Clinical and medical work have been undertaken in order to build up the necessary data required for the PoC approach, in respect of the two clinical domains: cancer and cardiovascular diseases. Data from these exercises has been compared and reviewed by partners so as to develop a sound PoC Model. The sequence of clinical activities has been carefully identified to provide an orderly and acceptable approach capable of being implemented on a prototype information system. Differences in approaches and nomenclature at different sites and different countries have been identified. Work was undertaken to establish a sound framework within which clinicians and medical teams at different sites could work relating particularly to procedures and common terminology.

The technical approach for Profiles of Care required the early establishment of a first prototype installed at different sites, under different organisational and technical circumstances. After an extensive review of the medical scope and of the user interface the consortium produced a functional analysis update that led to the PROCAS 2.0 platform; an advanced prototype for effective clinical usage.

At a clinical level, the work is providing a valuable contribution to developing effective methods of providing effective patient care.

Results, exploitations, demonstrator

The PoC model approaches the clinical process assuming that the doctor decision to "use" diagnostic or therapeutic procedures is linked to the patient problems and the doctor objectives.

PROCAS is mainly a "smart' Order Entry (OE) software that implements the PoC approach suggesting potential procedures related to the clinical standardised guidelines. The PoC approach tries to identify and standardise reproducible blocks of problems and working diagnoses for each pathology, and associates them with corresponding objectives and procedures. Furthermore the clinical guideline is split into a series of decisional processes (from the initial problem to the final diagnosis). Each step called Health Care Plan (HCP) contains "potential procedures" (identified by "clinical consensus") and relationships among different HCPs. The PoC software follows the patient generated flow of information and stores data generated by the clinical process.

QA on clinical process is performed through the comparison between observed and expected actions (process evaluation) and outcome evaluation.

The first PoC tested in the PROCAS project is related to Breast Cancer. The clinical process is described by five different HCPs: 1) Lump or mass in breast; objective: make diagnosis; 2) Malignant neoplasm breast: obi make diagnosis; 3) Malignant neoplasm breast objective: staging of disease; 4) Malignant neoplasm breast: objective: treatment surgical; 5) Malignant neoplasm breast; objective: treatment medical. The actual work is related to testing the Breast Cancer PoC in different clinical environments to validate the PROCAS software and the QA process.

A second PoC related to Prostate Cancer is under final validation. Using these two PoCs clinical experimentation was performed retrospectively on 150 case notes to start the quality assurance process in real clinical environment.

A key issue for effective collection and exchange of medical data, was the availability of a coding and classification system to reduce variability in terminology and clinical practice. Various options, already available on the market have been considered. Experimental use of the READ, ICD-9-CM and ICD-10 classification systems was performed.

Description of demonstrator

The main functions related to the order entry system, involve an Admission module, and the Profile of Care creation module. By entering a diagnosis/problem and the specific objective, the system will lead the doctor across the Health Care Plan creation helping him to choose the procedures for this specific diagnostic step. The procedures performed during the previous steps are highlighted, thus avoiding a duplication request. Those procedures which should have already been performed in each step of the diagnostic/therapeutic path, are also summarised.

The discharge feature will fill in automatically the clinical abstract, taking the basic data from the Profile of Care, and allowing the doctor to enter the final modifications.

The Medical Audit activity is made possible by the production of different reports. A global view of the patients profiles or a deep look insight a single profile of care, performing a sophisticated analysis between the potential and the effective health care plans, may be obtained.

The Data Base Administrator functionalities allow to define the hospital structure and to manage the potential health care plans according to the specific requirements.

Potential benefits

Future plans

1) Industrial Impact.

As for the market the idea behind PROCAS is so advanced and wants so many and profound changes in the culture and in the attitude of those to whom it is addressed that it is difficult to think of a large-scale exploitation of the product.

Nonetheless the success of the PROCAS Project, with the achievement of its objectives, has raised much attention and some of the Partners are in touch with some leading industries which have real interest in including a Profile of Care system into existing Health Care Information Systems.

2) Health/Social Impact.

The objective of the Project has been to realise a prototype system which will contribute to clinical and management decisions on appropriate and economic health-care.

The base-idea under the POC is a means to evaluate the present wide variation and the escalation of costs which may not always be justified,

3) Obstacles and difficulties.

Some problems were encountered while loading actual patients' data into the system. These were mainly due to the coding classification, since it was discovered that it was not possible to use one classification to code all the entities foreseen by PROCAS. So we had, on the one hand, to use different coding classifications (ICD9-CM for diagnoses and most of the procedures, Read Code for therapies), on the other, we had to "invent" our own codes to classify items like "consultation" that could not be found in any international classification available.

List of Deliverables

Year 1

• System macro specification (3/S/I)
• Project management manual (3/R/I)
• Project management package (3/T/I)
• First profile of care model (4/O/L)
• Thesaurus of clinical terminology (6/R/L)
• Telematics statement (5/R/R)
• Evaluation requirements (5/R/L)
• System specification (6/S/I)
• Application module set (10/O/I)
• Test rig built (12/O/I)
• Test report (12/R/R)
• User training plan (12/R/L)

Year 2

• PTT arrangements (1/R/L)
• Site acceptance (3/R/I)
• Help desk operational (3/T/I)
• Operations manual (3/R/I)
• Outcome process and methods (4/R/P)
• Training manual for doctors (4/R/L)
• First stage evaluation (6/R/L)

Year 3

• Site demonstrators (9/P/P)
• Systems options guidance (9/R/P)
• Profile of care workshops (9/O/P)
• Evaluation report (12/R/L)

List of Participants

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