Chemotherapy cancer treatment is a complicated business and introducing new drugs can take months. In a move to tackle this problem the NHS, the drug industry and the IT sector collaborated to develop software, now available on the Internet, that has reduced development time for new drugs from three months to a few hours.
The speedy treatment of cancer is a major objective of the NHS, with the effective delivery of chemotherapy treatment a key plank in that strategy. But when a major 2004 governmental review found imbalances in what drugs were being made available to clinicians across different locales in England, and that the adoption of new drugs was slower in the UK than in the rest of Europe, clearly action needed to be taken.
One of the barriers to consistent use of chemotherapy cancer treatment is the complexity of its delivery. Cancer drugs are complicated to prepare, difficult to administer, and come in many hundreds of treatment “regimens” – combinations of different drugs in different doses. This makes it very difficult for hospitals to plan for the introduction of new drugs, or to monitor which drugs are being used. How could this process be improved?
One immediate development was the creation of the Pharmaceutical Oncology Initiative Partnership (POIP). This is a partnership between 12 leading pharmaceutical companies who are members of the Association of British Pharmaceutical Industry (ABPI), plus the Department of Health/Cancer Action Team and the NHS/ Cancer Services Collaborative Improvement Partnership (CSCIP).
To try and get more uniformity in the targeted use of cancer treatment medicine, a special capacity planning application has been commissioned by POIP to aid the 33 so-called ‘cancer networks’ – the local and regional delivery teams charged with responsibility for co-ordinating the delivery of care and the introduction of new cancer drugs.
The tool, a capacity planning system based on Microsoft technology, is called the C-PORT (Chemotherapy-Planning Oncology Resource Tool). The system was developed by a number of partners across the NHS, government, the drug industry and the IT sector, with the final team being supported by business consultants A.T. Kearney. UK database technology specialist organisation Concentra was one of the primary technology partners for the final Web-based version of the system, which started to be rolled out across the NHS in November 2006, less than ten months after the project was given the green light.
Today it can take up to three months for a chemotherapy unit to plan for the introduction of a new cancer drug. Using C-PORT, the changes required to deliver a new therapy can be determined in a few hours – and with much more accuracy than using a manual process.
In its current state the tool is acting as a sophisticated simulator and powerful tool for service improvement and planning. C-PORT is mainly used to help clinicians and managers work out what the impact of a change in clinical practice will be before it is implemented. Given that it can simulate practically anything that can happen in a chemotherapy unit, it can be used for a number of ends, from understanding the impact of changes in numbers and types of patient to mapping the impact of adding new regimens and treatments to changing the way the unit is organized or altering the level of resource available. It is helping managers better process budget requests and business plans, test contingency plans (e.g. an Asian flu outbreak), compare the expected variability of drug usage and resources within and between units and networks, and finally test and fine-tune the implementation of best practice.
The development of the tool involved teamwork between some 12 pharmaceutical companies, 26 NHS Cancer Networks in England, the NHS Cancer Services Collaborative and the Cancer Action Team of the Department of Health. It has been introduced in over 160 hospitals throughout 34 NHS networks and gained enthusiastic support from clinicians, pharmacists, nurses, managers, and service improvement leads. It had also gained endorsement at the top of the National Health Service as an essential tool to improve cancer service delivery. One of the first.
True co-operation has led to truly usable software
This level of co-operation is a real landmark in terms of NHS IT, say participants. “This project is one of the first where the NHS has worked closely with industry colleagues in a partnership to improve services for patients,” notes Jane Whittome, Associate Director NCAT for the NHS. “At times it has been a challenge co-ordinating the way and speed at which different companies work. The objectives of each of the partner organisations are now being met and it is a test of the commitment of the team that we continue to develop the system together”.
Whittome also praises the usability of the finished product. “Whatever we were going to develop it had to be something that could be taken by every chemotherapy delivery suite in the country it needed to be something that could be used by everybody.
Technology innovation, technology satisfaction
The C-Port application has been custom-made to account for the very specific requirements of chemotherapy units. The software is a Web based .NET application with complex simulation logic written in the T-SQL programming language on top of a Microsoft SQL Server 2005 database. The web application runs under Windows 2003 Server with Internet Information Services 6.0. Other advantages of this implementation is that C-PORT is entirely web-based, so users only require access to a web-browser to use it; it is centrally hosted, which means it is easy to maintain, fast, and data is very secure. The tool is supported on a national scale by comprehensive documentation, training, user groups and a dedicated helpdesk resource.
C-Port is an innovative application for the NHS in that it applies advanced modelling techniques to tackle the problem of chemotherapy cancer treatment capacity planning, which has never been done before. The tool also makes use of leading edge techniques in so-called simulation. This means it can let users forecast how each individual patient will experience care, how long they wait, who they see, and when. It also creates in simulated form real life events that influence treatment such as equipment breakdowns, phone calls, meetings and absenteeism.
It’s expected that the system and methodology can be used in other areas in the NHS.
Concentra’s contribution – now and ongoing
Concentra was selected because of its strong experience in the healthcare sector, having developed a UK Clinical Research Network system in the recent past and its strong management team in the UK.
Concentra was responsible for delivering all the IT components on the project, providing the technical designs and specifications which included usability testing and user interface design at the beginning. Throughout the project Concentra worked closely with partners in order to provide all the technical expertise to code the application. On an ongoing basis Concentra is supplying user support of C-Port and hosting and continues to develop the system with all the partners.
Pharmaceutical Oncology Initiative Partnership
The Pharmaceutical Oncology Initiative Partnership (POIP) was set up 2005 to identify opportunities to collaborate on projects to benefit cancer patients by improving uptake and access to cancer drugs. The partners include the Cancer Action Team (DH), Cancer Services Collaborative ‘Improvement Partnership’ (CSC’IP’) and 12 member companies of the Association of the British Pharmaceutical Industry (ABPI).
Built on Microsoft .Net with complex simulation logic written in the T-SQL programming language on top of a Microsoft SQL Server 2005 database. The web application runs under Windows 2003 Server with Internet Information Services 6.0.
Many stakeholders are benefiting from the C-PORT project. Patients are getting shorter waiting times on their chemotherapy cancer treatment days, plus improved access to new therapies. The government is getting better visibility on resources and patient mix at national level and a better understanding of variations in drug usage and clinical practices, all of apiece with the move to performance based results. The NHS has taken a big step towards a more standardised way of evaluating the impact of new drugs, plan resources, do business planning and change working practices. And finally pharmaceutical companies will benefit from a new approach to cooperation with the NHS and a better and more consistent uptake of new cancer beating drugs.
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