1. Fondazione IRCCS
Istituto Nazionale dei Tumori
Fondazione IRCCS
Istituto Nazionale dei Tumori
Session 6 - Integrating mHealth into the Hospital Environment
AIDC and Mobile technologies supporting innovation
in Clinical Process Management
Michele Torresani
Fondazione IRCCS Istituto Nazionale dei Tumori di Milano
14 May 2013 Dublin, Ireland

2. Who’s who
Founded in 1925, the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan is a
top-tier Scientific Research and Treatment Institution in the field of pre-clinical and
clinical oncology research and care
INT in 2011:
• 13,700 in-patients
• 9,600 day-hospital patients admission
• 482 beds
• 1,1 milions out-patients treatment
• 11,500 surgical operations Istituto Nazionale dei Tumori
Fondazione IRCCS
Istituto Nazionale dei Tumori
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• 11,500 surgical operations
• ≈ 1,900 employees
• ≈ 230 Ml€ budget
• ≈ 2% ICT budget
• 18 ICT staff people
• 13,000 HD tickets resolved
• 2,000 workstations
Istituto Nazionale dei Tumori
Amadeo Lab
Cascina Rosa

3. Outline
• Clinical Process Management: open issues and ICT support
• Applying ICTs at Istituto Nazionale dei Tumori di Milano
• The stem cells project
• Lessons learned
Fondazione IRCCS
Istituto Nazionale dei Tumori
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4. Scope of the Analysis
Most of the threats to patient safety are process-related, rather than clinical. Some
Including a number of different processes as
pharmacotherapy, chemotherapy, radiotherapy, blood
transfusions, medications, and more
Clinical Process Management involves aspects of both
diagnostic and therapeutic processes, in terms of staff
workflow activities and direct contact with the patient
Fondazione IRCCS
Istituto Nazionale dei Tumori
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Access to patient information Often time-expensive
Professionals roles and clinical procedures High complexity
Procedures, documents and clinical practice Not standardized
Traceability of activities Difficult, paperwork
Share of knowledge and expertise Limited, data dispersion
Technology application supporting the process Local and specialty-related
Most of the threats to patient safety are process-related, rather than clinical. Some
issues are:

5. ICT tools supporting clinical processes
Automatic Identification
and Data Capture
(AIDC) Technology
• Bar Code
• Card Technologies
• Radio Frequency Identification
• Real Time Locating Systems
• …
Mobile&Wireless
solution
• Personal Computer
• Tablet PC
• Personal Digital Assistant (PDA)
• Smartphone
• …
Electronic Patient
Record
It is responsible for the
centralized management of
patient's data and
documents during each
clinical episode
Fondazione IRCCS
Istituto Nazionale dei Tumori
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• … clinical episode
Although the high potential of ICTs in Clinical Process Management there’s a lack of adequate
solutions supporting together process safety, clinical activities and clinical risk management
Many organizations started ICT projects based on Mobile AIDC integrated solution
• To ensure reliable patient identification throughout all processes
• To enable process traceability
• To support clinical staff in performing activities
• To improve governance and cost control

6. Outline
• Clinical Process Management: open issues and ICT support
• Applying ICTs at Istituto Nazionale dei Tumori di Milano
• The stem cells project
• Lessons learned
Fondazione IRCCS
Istituto Nazionale dei Tumori
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7. Blood Transfusion Chemoterapy Stem Cells
transplantation
Operating Room
and Biobanking
Mobile Clinical Process Management platform
Process traceability & safety of bedside operations
Fondazione IRCCS
Istituto Nazionale dei Tumori
ICT infrastructure
Hospital Information System (HIS)
Staff & Patient
identification
7

8. Safer Transfusions with the RFId mobile solution
Fondazione IRCCS
Istituto Nazionale dei Tumori
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Adopting
CDOs

9. Integrated approach to Chemotherapy
Patient identification
(RFId wrisband)
Therapy
prescription
Chemotherapy
compounding
Therapy
administration
INT’s RFId traceability platformINT’s RFId traceability platform
Fondazione IRCCS
Istituto Nazionale dei Tumori
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Key elements of innovation:
• Assurance of patient identification
• GMP Compliant laboratory for compounding of Cytotoxic, Non-cytotoxic, TPN,
Experimental drugs
• Process Traceability and Quality monitoring through digitalization of all information flows
Therapy management systemTherapy management system
INT’s RFId traceability platformINT’s RFId traceability platform

10. Surgical samples trasportation with a smart trolley
Sample transportation from the OR to the AP lab is managed and traced through a
smart trolley that allows:
• RFId detection of new tissue samples taken from surgery and loaded on the cart
• Tracking process lead times
• Temperature monitoring (RFId active sensors)
Fondazione IRCCS
Istituto Nazionale dei Tumori
Samples
Rfid
detection
User
authentication
(RFId badge)
Sample’s
temperature
monitoring
10

11. Outline
• Clinical Process Management: open issues and ICT support
• Applying ICTs at Istituto Nazionale dei Tumori di Milano
• The stem cells project
• Lessons learned
Fondazione IRCCS
Istituto Nazionale dei Tumori
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12. Stem cells management and transplantation
Research
INT’s dr. Montefusco leads the research project, funded by the Italian Ministry of Health
Fondazione IRCCS
Istituto Nazionale dei Tumori
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Transfusion Service Stem Cells Lab Transplantation
Unit
Project aims:
• General value process model
• ICT solution, interoperable with the
HIS, supporting the whole process
Project aims:
• General value process model
• ICT solution, interoperable with the
HIS, supporting the whole process
• Process fragmentation through
different Units
• Lack of adeguate IT support at tank-
and bed-side
• Paperwork
• Process fragmentation through
different Units
• Lack of adeguate IT support at tank-
and bed-side
• Paperwork

13. RFId and mobile IT support to stem cells process
…
…
…
…
……………
………………
………………
…
FractioningDonation Pre-storage Storage
CASE
(bag in
aluminum)
ID
ID+1
RackA
A1
A2
1
ID+2
……ID+1
Fondazione IRCCS
Istituto Nazionale dei Tumori
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…
………………
………………
CheckDe-freezeAdministration
Liquid Nitrogen
Tank 1
ID
Rack
A3
A4
1
ID+n
…ID+1
ID+1
…
ID+1
PickingStock check

14. Mobile solution for laboratory logistics
Android app (with NFC)
Stem cells bag
Storage location recording
Fondazione IRCCS
Istituto Nazionale dei Tumori
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Stem cells bag
Liquid Nitrogen tank and racks
Picking support

15. Outline
• Clinical Process Management: open issues and ICT support
• Applying ICTs at Istituto Nazionale dei Tumori di Milano
• The stem cells project
• Lessons learned
Fondazione IRCCS
Istituto Nazionale dei Tumori
15

16. Adoption of innovation in Public HDO meets a lot
of difficulties due to deep-rooted organizational
habits and rules.
This is stronger in Bureaucratic organizations are
focused on Functions, while a process-driven
approach is needed
Discussion
Implementing RFID technology enterprise-wide is not so
easy because extensive tests are needed to assess
Fondazione IRCCS
Istituto Nazionale dei Tumori
Specific laws and implementation guidelines would assist
HDOs in effectively introduting RFId technologies.
Electromagnetic compatibility tests are needed to ensure
safety of applications (especially affecting biological materials)
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easy because extensive tests are needed to assess
interoperability between different solutions.
Co-design is reccomended for achieving effective
solutions that aren’t off-the-shelf

17. Fondazione IRCCS
Istituto Nazionale dei Tumori
Fondazione IRCCS
Istituto Nazionale dei Tumori
Thank you!
Michele Torresani
michele.torresani@istitutotumori.mi.it