Since the introduction of a special software and optimization of patient management practices in November 2015, in the Hungarian county of Kaposvár the average time from the discovery of a cancerous disease until the actual medical consultation about the treatment plan has been reduced drastically from 54 to 21 days. Those 33 days could mean the difference between life and death. Sometimes you do not need pricey or hyper-high-tech solutions for making a difference in healthcare. Sometimes it is enough if you respond to patients’ needs by optimizing processes. Let’s see how OnkoNetwork, the first Hungarian patient management network did.

The golden rule in oncology: the sooner the diagnosis, the higher chance for survival

According to statistics, every year more than the quarter of all deaths in Hungary is caused by cancer. It means 30-33 thousand people, thus the population of a small town in the Central European country. Every year there are more than 50 thousand new cancer patients – more than 130 every day!

Although there were some promising investments in new equipment and the development of new healthcare methods mean the rise of the survival chances for cancer patients also in Hungary, the healthcare system is on the brink of falling entirely apart. There are huge problems in the overall patient management system (not to speak about the acute shortage of medical professionals in the country or the generally catastrophic state of affairs), which make the prospects of Hungarian patients rather bleak.

The team of OnkoNetwork in Kaposvár wanted to change the current situation in oncology patient management, and live up to the golden rule that if the diagnosis is set up sooner, the chance for survival is significantly higher. According to their own statistics, there were patients who had to wait 196 days (I repeat it: 196 days!!) from the discovery of the tumor until the oncology team session deciding about treatment before they introduced the system. Such a long waiting time could easily cost someone’s life!

And it is even worse if we consider the fact that Hungarian healthcare institutions identified already how important fast diagnosis and treatment is, since they introduced the 14-day-rule. It means that in case of the strong probability of cancer, hospitals have to do an MRI or CT within 14 days.

Oncology Patient Management

OnkoNetwork and stroke cases in Tirol

Although the OnkoNetwork patient management system was launched in November 2015, the introduction of the new system required a lot of preparation. A research team from the Kaposi Mór Medical Teaching Hospital in Somogy County, the University of Kaposvár Healthcare Centre, the Hospitaly Healthcare IT Development company and other healthcare professionals worked for one and a half year on the methodology of the oncology patient management system. Then, upon its completion, Hospitaly developed the OnkoLogistics software supporting the new system.

Fortunately, they had some experience already and they kept an eye on several international examples. Formerly, Hospitaly developed a system to provide IT help for physicians with the aim of managing referrals from a cost-efficiency point of view.

Gyula Király, leader of Hospitaly told me that they have taken into consideration various patient management systems as well, such as the patient path guiding system introduced by the Danish government, a coordination program used in France for treating chronic patients, innovations to handle acute stroke cases in the Austrian Tirol, cardiology patient care in the Netherlands or patient management systems within Germany.

Patient Management System

How does the system work?

The OnkoNetwork office is the heart of the system with four administrators and two supervisor physicians working part-time. Their task is to help the communication with specialists. Overall, the patient management system is used by 134 nurses in 58 departments daily.

The cases are recorded and followed closely from the moment that a patient turns to the hospital until finishing the therapy. The patient pathway coordinators organize the onco-team sessions and make sure that each participant, including the patient shows up for all the relevant appointments in time. There is even a follow-up protocol, which reserves the diagnostic capacities for 5-7 years in advance and monitors the deadlines for diagnostics, examinations, surgeries and therapies. The whole system is supervised on a patient pathway dashboard by the patient pathway coordinators.

Patient Management in Oncology

And what does oncology patient management look like in real life?

Let’s look at Irma, who is 53 years old, works in a small-town grocery store and lives with her husband and their little dog called Bogi. One day Irma discovers a strange swell in her armpit. She goes to her GP and the doctor gives her a referral suspecting an oncology case. In a couple of days, Irma has to show up at the reception desk of the hospital in Kaposvár. If she does, she is directed to the appropriate unit and the OnkoNetwork asks her whether she would like to be managed by the system. It is certainly not obligatory.

In case Irma consents to the OnkoNetwork management, she should fill out certain documents and when the case with the details is opened in the OnkoLogistic system, among others it automatically calculates deadlines for examinations and the onco-team sessions. As Irma undergoes various examinations, the OnkoLogistic system collects the results and updates the status of the case. If Irma forgets an appointment or any deadline is missed, the office staff intervenes. After the examinations, the onco-team makes a decision about the diagnosis and the therapy. In case of every surgery and treatment, the system updates the status of the case, and it does a follow-up even after the therapy is finished.

Patient Management Phone Call

Simple steps, astonishing results

Although the system is still relatively new for making definitive conclusions, Gyula Király said that it is already visible how significantly the time period necessary for diagnosing the patient until the decision about therapy shortened. The average time of examination decreased by almost 70% (!), giving a greater chance for surgical operations in case of certain oncological diseases, for a more efficient therapy, as well as for a lower cost of healing on the level of society.

Another benefit of the system was that favouring certain patients for others was cut out, so improvement in equal opportunities for patients was tangible.

Patients were positively surprised about being informed, physicians saw problems in transparency

Obviously, the system’s main beneficiaries are the patients and their reactions are very positive. They are surprised about actually being informed and being called in case of problems, having their pathway organized and getting acquainted with treatments in details, says Gyula Király. My educated guess would be they are stunned by the attention as they had some less reaffirming experience with the Hungarian healthcare system (to put it diplomatically).

There is a slightly less enthusiastic attitude from the medical community. Although there are no real arguments against the system, many physicians regard transparency as well as the objective nature of checkpoints incorporated in the process problematic. They also look suspiciously at the patient pathway coordinators, who get more confident regarding effective patient management over time.

The leader of Hospitaly believes that professional organisations are also not keen on widening the reach of the system, and the reason is that they regard the results as “too simple”. That it was not achieved by expensive equipment, innovative new drugs or scientific research, but “only” by methodological and process management solutions.

Patient Management in Hospital

Any chance for spreading out the wisdom?

Although the Hungarian National Healthcare Services Centre (NHSC) – as the manager of Oncology Centres – supports the nation-wide roll-out of the system, they have not yet taken any actual steps, Gyula Kiraly pointed out. So far, only a single regional oncology centre followed the Kaposvár pattern.

It is disappointing, since I agree with Hospitaly’s leader when he says that the social and health benefits of the system reach far beyond the common benefits of an IT solution. Moreover, the patient management method can be implemented anytime, anywhere, at any extent, with no need to change the present medical systems.

But let’s stay hopeful and have some confidence in the sound judgement of future healthcare leaders, who will realize the immense potential in the system. Because sometimes you do not need pricey or hyper-high-tech solutions for making a difference in healthcare, sometimes it is enough if you pay attention to patients by optimizing processes.

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