Download Prototype_COMS_Stage2_Demonstration_1_Minutes_20131217

Veterans Affairs Center for Innovation
VHA Innovation Program
Chemotherapy Order Management System
Event
Date
Time
Location
Attendees
Stage 2 Demonstration #1 – Chemotherapy Order Management System (COMS)
December 13, 2013
2:00 – 2:45 p.m. ET
1.877.771.2574, Code 961.612.0419; https://global.gotomeeting.com
Name
Devin Harrison
Dr. Daniel Wu
Linda Arsenault
Chuck Boyd
Abraham Enfiedjian
Zach Forrest
Robyn Guy
Eileen Gormly
Julia Hammond
Molly McCarthy
Ellen Nason
Ed Null
Craig O’Brien
Danielle Retland
Marvis Thompson
Kristen Williamson
Mike Barlow
Sean Cassidy
Pat Tracy
Lou Ferrucci
Organization
VHA Innovation Program
VA – Puget Sound VAMC
VA
VA
VA
PWC
VA
VA
VA
PWC
VA
PWC
VA
PWC
VA
VA
dbITpro*
dbITpro*
CACI
CACI
Role
Contracting Officer Representative (COR)
Pilot Site Lead Innovator
Stakeholder
Stakeholder
Stakeholder
COR Project Support
Stakeholder
Stakeholder
Stakeholder
COR Project Support
Stakeholder
COR Project Support
Stakeholder
COR Project Support
Stakeholder
Stakeholder
Senior Developer
Technical Architect
Vice President, Healthcare Delivery Support
Project Manager
*dbITpro is a subcontractor for Team CACI
Purpose and Attachments
Demonstration for the first development sprint of Stage 2 Enhancements for Prototype COMS
T4-0299 project (VA118-1007-0014). The attached slide deck includes the agenda for this
meeting to demonstrate advancement of Proof of Concept (PoC) COMS.
Minutes
Lou Ferrucci opened the meeting by thanking attendees for their participation.
 Verifying attendance through the GoToMeeting log, he requested announcement of
those on the conference call who were not logged into the GoToMeeting.
 He indicated the demonstration was the result of the first sprint within the Stage 2
Enhancement Period and presented the agenda, as depicted on slide 2.
Prototype COMS Stage 2 Demonstration
1
Author: Team CACI
Veterans Affairs Center for Innovation
VHA Innovation Program
Chemotherapy Order Management System


Team CACI will provide demonstration of all items prior to formally listing them as
“Closed”. Lou provided an overview of the status of enhancement and development
activities, noting items are stratified into three categories as follows:
o Product Backlog – PoC
 These 64 items were originally identified by PoC COMS Stakeholders and
deferred for higher priority concerns. To maintain the source integrity of
functionality requests, the total count of open plus closed items on this list will
remain constant throughout the Prototype COMS project. Agile development
efforts will “burn down” this backlog to 0 Open and 64 Closed.
 64 Open, 0 Closed, 2 for presentation today
o Product Backlog – Prototype
 This list includes functionality requested by the current group of Prototype
COMS Stakeholders. These items may complement or supplant items on the PoC
Product Backlog and the total count will fluctuate throughout this project as new
functionality requests are added and entries are subsequently closed.
 5 Open, 0 Closed, 2 for presentation today
o Defect Log
 This list tracks application defects and will fluctuate with the opening of new
issues and closure of fixed defects.
 19 Open, 0 Closed, 4 for presentation today
Lou introduced Sean Cassidy as the COMS Architect to provide the demonstration of
enhanced functionality.
Sean Cassidy welcomed attendees and thanked them for attending the meeting. He provided
the demonstration of COMS enhanced functionality as follows:
 Product Backlog – POC items
o Exact Minute Annotation of Medication Administration within Treatment Panel
 During PoC COMS development, Stakeholders had identified the requirement to
modify the recording of medication administrations to the “exact minute” vice
the originally-designed functionality of 15-minute increments.
 Sean demonstrated enhanced functionality to permit exact minute entry for
medication start time/end time by two methodologies. Users may begin
entering the time and the pull-down menu will present a.m./p.m. options for
selection. Alternatively, users may access the pull-down menu and scroll to the
desired exact minute. If using the pull-down methodology for end time, COMS
displays the entered start time at the top of the scroll to shorten search time.
o Medication Selection – Intravenous Push (IVP) Medications Do Not Require Fluid
Information
 During PoC COMS development, Stakeholders had noted fluid information is not
required for medications with IVP as the route of administration. These differ
from IVPB (IV piggyback) routes as they are directly administered from the
syringe vice administered through an IV fluid.
Prototype COMS Stage 2 Demonstration
2
Author: Team CACI
Veterans Affairs Center for Innovation
VHA Innovation Program
Chemotherapy Order Management System



Sean demonstrated enhanced Chemotherapy Template Order Source (CTOS)
Module/Template Authoring functionality to no longer require fluid information
(e.g., fluid type, fluid volume, flow rate, infusion time) for medications with IVP
routes of administration within regimen templates. Conversely, these remain
mandatory fields for IVPB routes of administration.
o The two Product Backlog – PoC items were CLOSED, as demonstrated.
Product Backlog – Prototype items
o Rename “Patient History” Panel to “Patient Vitals”
 As requested by Stakeholders during the Stage 1 Demonstration, this panel was
renamed to more accurately reflect its contents.
o Rename “Nursing Documentation” Module to “Treatment Documentation”
 As requested by Stakeholders during the Stage 1 Demonstration, this module
was renamed to more accurately reflect the non-discipline specific inclusiveness
of its activities. This is now named the Treatment Documentation (TD) Module.
o The two Product Backlog – Prototype items were CLOSED, as demonstrated.
Defect Log items
o Null Object when Loading Patient and Failure to Load Patient
 These two defects were related; each prevented proper loading and display of
patient information once the patient was selected.
 Sean demonstrated proper retrieval and loading of information for requested
patients. He noted COMS was configured to retrieve patient information from
Medical Domain Web Services (MDWS) and it was providing slower response
times. The null object error was a result of the site list originally configured for
355; however, the 355 site list is no longer operational or has been taken down.
COMS now accesses the default site list of 901 and this may be the cause of the
slowness. Renewal of a MDWS instance dedicated to Prototype COMS would
mirror medical facility configurations and likely accelerate the retrieval process.
Team CACI will open a Help Desk ticket with the Innovation Sandbox.
o Change Performance Status
 This functionality did not perform as expected during the Stage 1 Demonstration
and has been corrected during this sprint.
 Sean demonstrated the capability within the Order Entry Management (OEM)
Module that enables the provider to upgrade or downgrade the patient’s
performance status consistent with the ECOG scale (Eastern Cooperative
Oncology Group; as accepted and utilized within VA Oncology Services).
Selection of the “Change Performance Status” link enables the provider to
reassign the patient’s performance status on the 0 thru 4 ECOG scale.
o TD Module / Treatment Panel – Annotating Administrations
 This defect related to the proper display of the Pre-Therapy, Therapy, and PostTherapy medication lines following annotations of administration. Specifically,
the information display was “cleared” following signature; whereas the
information should remain visible for the administration day.
Prototype COMS Stage 2 Demonstration
3
Author: Team CACI
Veterans Affairs Center for Innovation
VHA Innovation Program
Chemotherapy Order Management System

Sean demonstrated the medication line remained visible following annotation of
medication administration – dosage, start time, end time, and comments – and
signature by the verifying healthcare professional. Stakeholder discussion
resulted in a new item for the Product Backlog – Prototype. Specifically, Batch
Signing of Medication Administrations should include ability to specify which
records to batch sign, but also afford flexibility to individually sign medication
administrations.

Devin Harrison asked about the origination of the functionality requirement
to sign each record individually. Lou Ferrucci indicated the PoC COMS
Stakeholders had identified the requirement for “positive action” to indicate
medications were administered.

Following further discussion, Stakeholders determined functionality should
permit batch signature then designate each medication line as “signed” once
access code/verify code credentials are authenticated. If only a portion of the
medications are signed during the session, the balance of medications
dispensed will remain available for administration and signature by the
current user or another user. This will satisfy safety and efficiency concerns.

Sean stated the desired batch signing functionality can be designed and Lou
indicated the request would be entered into the Product Backlog.
o The four Defect Log items were CLOSED, as demonstrated.
o Sean discussed the relationship between the TD Module / Treatment Panel and the
Flow Sheet (FS) Module. Once medications are verified as administered, they are
displayed on the FS information display. However, that functionality failed during
today’s demonstration, resulting in a new Defect Log item for Medication Not
Pushed to Flow Sheet.
o During the brief review of the FS Module, Stakeholders discussed the merits of
collapsible/expandable views by regimen cycle. The FS display currently collapses
and expands for information categories (e.g., General, Laboratory Results, and PreTherapy, Therapy, and Post-Therapy medications). Stakeholders requested the
addition of FS Collapsible/Expandable Views for the Product Backlog – Prototype to
enable column collapse/expand functionality similar to that currently provided for
rows. Sean stated the functionality can be designed and Lou noted the request
would be entered into the Product Backlog.
Lou Ferrucci presented the Product Backlog items projected for the next sprint, as shown on
slide 4. These include printing templates and paper orders, removal of medications from orders
via enhanced OEM module functionality, and the capability to edit/save templates with the
same name while ensuring unique user-friendly names for each saved template. Sean Cassidy
asked if there were any questions regarding activities for the next sprint and also noted that the
development team will work on Defect Log items. There were no questions/concerns
expressed by Stakeholders.
Prototype COMS Stage 2 Demonstration
4
Author: Team CACI
Veterans Affairs Center for Innovation
VHA Innovation Program
Chemotherapy Order Management System
Sean Cassidy discussed the availability of COMS within the Innovations Sandbox through
https://coms.vacloud.us/ as follows.
 Stakeholders will be provided user names/passwords for access to the COMS server;
Sean will also create “generic” credentials for unspecified providers, nurses, and
pharmacists who are not Stakeholders but invited to peruse the application.
o Sean asked if the Stakeholders would work in “clinical teams” or individually. Dr. Wu
indicated Stakeholders will work independently as individuals for now.
o Lou stated that natural team formation may occur since COMS mirrors clinical
practice and progression of a patient through the application would require
provider, nurse, and pharmacist actions.
 Stakeholders requested assignment of some “all functionality” credentials to permit full
exploration of COMS capabilities. Sean indicated this could also be provided.
Lou Ferrucci added that the COMS version presented today will remain available on the
Innovations Sandbox and may be accessed by any computer with an internet connection. He
noted our upcoming demonstration schedule with next meeting on January 3, 2014 and asked
for any closing comments from the Lead Innovators, COR, and other Stakeholders.
 Dr. Wu stated COMS is progressing nicely.
 Devin Harrison thanked all participants for attending today and expressed appreciation
for participation in the demonstration.
 No further comments were offered by other Stakeholders.
Lou concluded the meeting by thanking attendees for taking the time to participate in the Stage
2 Demonstration for enhanced functionality and wishing everyone happy holidays. The
meeting concluded at 2:45 p.m. ET.
Attachment:
Meeting Slide Deck
Prototype COMS Stage 2 Demonstration
5
Author: Team CACI