Abstract
By the year 2020, potentially one-half a million hematopoietic cell transplant (HCT) recipients will need long-term follow-up care to address not only chronic GvHD but also multiple other late consequences of transplant. Despite this increase in patients, there will not be a concomitant increase in the HCT workforce. Thus, the future of long-term patient management will require a new 'next-generation' clinical model that utilizes technological solutions to make the care of the HCT patient efficient, safe and cost-effective. Guideline-based decision support will be embedded in clinical workflows. Documentation requirements will be reduced as automated data collection from electronic medical records (EMRs) will populate registries and provide feedback for a rapid learning health system. Interoperable EMRs will disseminate treatment protocols to multiple care providers in a distributed long-term clinic model, such that providers outside of the transplant center can provide services closer to the patient. Patients will increase their participatory role through patient portals and mobile devices. At Vanderbilt, we have responded to some of these future challenges by embedding guideline-based decision support, structuring clinical documentation and being early adopters of communication technology. This manuscript describes the current state of some of these innovations, and a vision for the future of the long-term transplant clinic.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Majhail NS, Tao L, Bredeson C, Davies S, Dehn J, Gajewski JL et al. Prevalence of hematopoietic cell transplant survivors in the United States. Biol Blood Marrow Transplant 2013; 19: 1498–1501.
Shahrukh HaL MR . Late effects after allogeneic hematopoietic stem cell transplantation. In: Savani BN (ed). Blood and Marrow Transplantation Long Term Management: Prevention and Complications. John Wiley & Sons Ltd: Oxford, UK, 2014, pp 21–31.
Martin PJ, Counts GW Jr, Appelbaum FR, Lee SJ, Sanders JE, Deeg HJ et al. Life expectancy in patients surviving more than 5 years after hematopoietic cell transplantation. J Clin Oncol 2010; 28: 1011–1016.
Savani BN . How can we improve life expectancy and quality of life in long-term survivors after allogeneic stem cell transplantation? Semin Hematol 2012; 49: 1–3.
Arai S, Arora M, Wang T, Spellman SR, He W, Couriel DR et al. Increasing incidence of chronic graft-versus-host disease in allogeneic transplantation: a report from the Center for International Blood and Marrow Transplant Research. Biol Blood Marrow Transplant 2015; 21: 266–274.
Khera N, Storer B, Flowers ME, Carpenter PA, Inamoto Y, Sandmaier BM et al. Nonmalignant late effects and compromised functional status in survivors of hematopoietic cell transplantation. J Clin Oncol 2012; 30: 71–77.
Socie G, Rizzo JD . Second solid tumors: screening and management guidelines in long-term survivors after allogeneic stem cell transplantation. Semin Hematol 2012; 49: 4–9.
Majhail NS . Secondary cancers following allogeneic haematopoietic cell transplantation in adults. Br J Haematol 2011; 154: 301–310.
Hashmi S, Carpenter P, Khera N, Tichelli A, Savani BN . Lost in transition: the essential need for long-term follow-up clinic for blood and marrow transplantation survivors. Biol Blood Marrow Transplant 2014; 21: 225–232.
Schriber JR, Anasetti C, Heslop HE, Leahigh AK . Preparing for growth: current capacity and challenges in hematopoietic stem cell transplantation programs. Biol Blood Marrow Transplant 2010; 16: 595–597.
Rizzo JD, Wingard JR, Tichelli A, Lee SJ, Van Lint MT, Burns LJ et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, Center for International Blood and Marrow Transplant Research, and the American Society for Blood and Marrow Transplantation (EBMT/CIBMTR/ASBMT). Bone Marrow Transplant 2006; 37: 249–261.
Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2012; 18: 348–371.
Gajewski JL, LeMaistre CF, Silver SM, Lill MC, Selby GB, Horowitz MM et al. Impending challenges in the hematopoietic stem cell transplantation physician workforce. Biol Blood Marrow Transplant 2009; 15: 1493–1501.
Majhail NS, Murphy EA, Omondi NA, Robinett P, Gajewski JL, LeMaistre CF et al. Allogeneic transplant physician and center capacity in the United States. Biol Blood Marrow Transplant 2011; 17: 956–961.
Wolff D, Ayuk F, Elmaagacli A, Bertz H, Lawitschka A, Schleuning M et al. Current practice in diagnosis and treatment of acute graft-versus-host disease: results from a survey among German-Austrian-Swiss hematopoietic stem cell transplant centers. Biol Blood Marrow Transplant 2013; 19: 767–776.
Ruutu T, van Biezen A, Hertenstein B, Henseler A, Garderet L, Passweg J et al. Prophylaxis and treatment of GVHD after allogeneic haematopoietic SCT: a survey of centre strategies by the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2012; 47: 1459–1464.
Lee SJ, Vogelsang G, Gilman A, Weisdorf DJ, Pavletic S, Antin JH et al. A survey of diagnosis, management, and grading of chronic GVHD. Biol Blood Marrow Transplant 2002; 8: 32–39.
Lee SJ, Astigarraga CC, Eapen M, Artz AS, Davies SM, Champlin R et al. Variation in supportive care practices in hematopoietic cell transplantation. Biol Blood Marrow Transplant 2008; 14: 1231–1238.
Sichel DE, Oliner SD . Information technology and productivity: where are we now and where are we going?. Board of Governors of the Federal Reserve System FEDS, Washington, DC,. 2002, pp 16–29 http://www.federalreserve.gov/pubs/feds/2002/200229/200229pap.pdf.
Buntin MB, Burke MF, Hoaglin MC, Blumenthal D . The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff (Millwood) 2011; 30: 464–471.
Lee J, McCullough JS, Town RJ . The impact of health information technology on hospital productivity. RAND J Econ 2013; 44: 545–568.
Huerta TR, Thompson MA, Ford EW, Ford WF . Electronic health record implementation and hospitals' total factor productivity. Decision Support Systems 2013; 55: 450–458.
Poissant L, Pereira J, Tamblyn R, Kawasumi Y . The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12: 505–516.
Halamka J, Aranow M, Ascenzo C, Bates DW, Berry K, Debor G et al. E-Prescribing collaboration in Massachusetts: early experiences from regional prescribing projects. J Am Med Inform Assoc 2006; 13: 239–244.
Warner J, Hochberg E . Where is the EHR in oncology? J Natl Compr Canc Netw 2012; 10: 584–588.
Yu P, Artz D, Warner J . Electronic health records (EHRs): supporting ASCO's vision of cancer care. Am Soc Clin Oncol Educ Book 2014; 34: 225–231.
Yu PP . The evolution of oncology electronic health records. Cancer J 2011; 17: 197–202.
Ohno-Machado L . Networking the country to promote health and scientific discovery. J Am Med Inform Assoc 2014; 21: 575 21575.
Dafny L . Hospital industry consolidation—still more to come? N Engl J Med 2014; 370: 198–199.
Humphreys A . Healthcare & life sciences M&A outlook. Bass, Berry & Sims 2014 Contract No. 1.
Koppel R, Lehmann CU . Implications of an emerging EHR monoculture for hospitals and healthcare systems. J Am Med Inform Assoc 2015; 22: 465–471.
Sittig DF, Wright A . What makes an EHR "open" or interoperable? J Am Med Inform Assoc 2015; 22: 1099–1101.
Joseph S, Snow M, Furukawa MF, Posnack S, Chaffee MA . HITECH spurs EHR vendor competition and innovation, resulting in increased adoption. Am J Manag Care 2014; 20: 734–740.
Blumenthal D, Tavenner M . The "meaningful use" regulation for electronic health records. N Engl J Med 2010; 363: 501–504.
Slavitt AM, Burwell SM . Medicare and medicaid programs; electronic health record incentive program-stage 3. Fed Reg 2015; 80: 16731–16804.
Williams C, Mostashari F, Mertz K, Hogin E, Atwal P . From the Office of the National Coordinator: the strategy for advancing the exchange of health information. Health Aff (Millwood) 2012; 31: 527–536.
Fridsma DBMPFFP, Ceo A . AMIA-Setting the standard. J Am Med Inform Assoc 2015; 22: 744–745.
Aljurf M, Rizzo JD, Mohty M, Hussain F, Madrigal A, Pasquini MC et al. Challenges and opportunities for HSCT outcome registries: perspective from international HSCT registries experts. Bone Marrow Transplant 2014; 49: 1016–1021.
Ezzone SA . History of hematopoietic stem cell transplantation. Semin Oncol Nurs 2009; 25: 95–99.
Kuwatsuka Y, Atsuta Y, Horowitz MM, Inagaki J, Kanda J, Kato K et al. Graft-versus-host disease and survival after cord blood transplantation for acute leukemia: a comparison of Japanese versus White populations. Biol Blood Marrow Transplant 2014; 20: 662–667.
Saltz J, Oster S, Hastings S, Langella S, Kurc T, Sanchez W et al. caGrid: design and implementation of the core architecture of the cancer biomedical informatics grid. Bioinformatics 2006; 22: 1910–1916.
Warner JL, Anick P, Drews RE . Physician inter-annotator agreement in the Quality Oncology Practice Initiative manual abstraction task. J Oncol Pract 2013; 9: e96–102.
Abernethy AP, Etheredge LM, Ganz PA, Wallace P, German RR, Neti C et al. Rapid-learning system for cancer care. J Clin Oncol 2010; 28: 4268–4274.
Patlak M, Murphy S . A Foundation for Evidence-Driven Practice: a Rapid Learning System for Cancer Care: Workshop Summary. National Academies Press: Washington, DC, 2010.
Friedman CP, Wong AK, Blumenthal D . Achieving a nationwide learning health system. Sci Transl Med 2010; 2: 57cm29.
Etheredge LM . A rapid-learning health system. Health Aff (Millwood) 2007; 26: w107–w118.
Institute of Medicine The Learning Healthcare System: Workshop Summary (IOM Roundtable on Evidence-Based Medicine). National Academies Press: Washington, DC, USA, 2007.
Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM et al. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20: e2–e8.
Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E . Clinical Practice Guidelines we Can Trust. National Academies Press, Washington, DC, 2011.
Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med 2012; 157: 29–43.
King J, Patel V, Jamoom EW, Furukawa MF . Clinical benefits of electronic health record use: national findings. Health Serv Res 2014; 49: 392–404.
In:Grossmann C, Powers B, McGinnis JM (eds). Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care. Workshop Series Summary: Washington, DC, USA, 2011.
Giuse DA (ed). Supporting Communication In An Integrated Patient Record System. AMIA annual symposium proceedings; 2003: American Medical Informatics Association.
Denny JC, Giuse DA, Jirjis JN . The Vanderbilt experience with electronic health records. Semin Colon Rect Surg 2005; 16: 59–68.
Giuse NB, Williams AM, Giuse DA . Integrating best evidence into patient care: a process facilitated by a seamless integration with informatics tools. J Med Libr Assoc 2010; 98: 220–222.
Ragon BK, Clifton C, Chen H, Savani BN, Engelhardt BG, Kassim AA et al. Geographic distance is not associated with inferior outcome when using long-term transplant clinic strategy. Biol Blood Marrow Transplant 2014; 20: 53–57.
Duncavage S, Mathe J, Werner J, Malin BA, Ledeczi A, Sztipanovits J (eds). A Modeling Environment for Patient Portals. AMIA Annu Symp Proc 2007; 2007: 201–205.
Collins SA, Vawdrey DK, Kukafka R, Kuperman GJ . Policies for patient access to clinical data via PHRs: current state and recommendations. J Am Med Inform Assoc 2011; 18: i2–i7.
Delbanco T, Walker J, Darer JD, Elmore JG, Feldman HJ, Leveille SG et al. Open notes: doctors and patients signing on. Ann Intern Med 2010; 153: 121–125.
Danciu I, Cowan JD, Basford M, Wang X, Saip A, Osgood S et al. Secondary use of clinical data: the Vanderbilt approach. J Biomed Inform 2014; 52: 28–35.
Roden DM, Pulley JM, Basford MA, Bernard GR, Clayton EW, Balser JR et al. Development of a large-scale de-identified DNA biobank to enable personalized medicine. Clin Pharmacol Ther 2008; 84: 362–369.
Bowton E, Field JR, Wang S, Schildcrout JS, Van Driest SL, Delaney JT et al. Biobanks and electronic medical records: enabling cost-effective research. Sci Transl Med 2014; 6: 234cm3.
Kesselheim AS, Cresswell K, Phansalkar S, Bates DW, Sheikh A . Clinical decision support systems could be modified to reduce 'alert fatigue' while still minimizing the risk of litigation. Health Aff (Millwood) 2011; 30: 2310–2317.
Lin CP, Payne TH, Nichol WP, Hoey PJ, Anderson CL, Gennari JH . Evaluating clinical decision support systems: monitoring CPOE order check override rates in the Department of Veterans Affairs' Computerized Patient Record System. J Am Med Inform Assoc 2008; 15: 620–626.
Hsieh TC, Kuperman GJ, Jaggi T, Hojnowski-Diaz P, Fiskio J, Williams DH et al. Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system. J Am Med Inform Assoc 2004; 11: 482–491.
Warner JL, Maddux SE, Hughes KS, Krauss JC, Yu PP, Shulman LN et al. Development, implementation, and initial evaluation of a foundational open interoperability standard for oncology treatment planning and summarization. J Am Med Inform Assoc 2015; 22: 577–586.
Smith A . Smartphone ownership–2013 update. Pew Research Center: Washington, DC, USA, 2013.
Hoverman JR . From the first visit on: information technology and communication. J Oncol Pract 2013; 9: 152–154.
Basch E, Reeve BB, Mitchell SA, Clauser SB, Minasian LM, Dueck AC et al. Development of the National Cancer Institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst 2014; 106: 1–11.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Rioth, M., Warner, J., Savani, B. et al. Next-generation long-term transplant clinics: improving resource utilization and the quality of care through health information technology. Bone Marrow Transplant 51, 34–40 (2016). https://doi.org/10.1038/bmt.2015.210
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2015.210
This article is cited by
-
‘Coming of Age’ of artificial intelligence: evolution of survivorship care through information technology
Bone Marrow Transplantation (2016)