Saturday , June 23 2018

Development and Evaluation of a Software-based
Clinical Pharmacography System

Nicolae TODOR1, Mihai BORZAN2*, Laura Elisabeta CIULEANU3, Dana Ioana IANCU4,Voichita Alexandra GHENGHEA5, Tudor Eliade CIULEANU4,6

1 Biostatistics and Medical Informatics Department,
”Prof. Dr. Ion Chiricuta” Oncology Institute,
34-36 Gheorghe Bilaşcu Street, Cluj Napoca, 400015, Romania
2 University of Agricultural Sciences and Veterinary Medicine,
3-5 Calea Mănăştur, Cluj Napoca, 400372, Romania (Corresponding author)
3 SC Vetomed SRL,
171 Calea Turzii, Cluj Napoca, 400495, Romania

4 Oncology Department, Oncology Institute „Prof. Dr. Ion Chiricuta”,
34-36 Gheorghe Bilaşcu Street, Cluj Napoca, 400015, Romania
5 Communications in Foreign Languages Department,
“Politehnica” University of Bucharest,
313 Splaiul Independenţei, Bucharest, 77206, Romania
6 Oncology Department, ”Iuliu Hatieganu” University of Medicine and Pharmacy,
34-36Victor Babeş Street, Cluj Napoca, 400012, Romania

Abstract: Objectives: Prescribing, dosing and delivering chemotherapy to the cancer patients is a complex, highly specialized and time consuming process, requiring a specialized team (medical oncology clinician or veterinarian, nurse, pharmacist). Our aim was to create a software that fills the gap between medical doctors, pharmacists and nurses and consequently speeds up the calculation, dosing and preparation of chemotherapy and biological (targeted) therapy in medical oncology. Dedicated versions for human and veterinary medicine are available.

Results: First version (chemotherapy and hormonal therapy in humans) was created in 1997 and the software was continuously updated. The 2014 update includes four versions (i.e. for humans or pets and standalone or network). The protocol library was extended to more than 800 chemotherapy protocols to include new chapters such as molecular targeted therapy and immune oncology. All 50 requirements and standards for achieving a good prescription from EuroRec EHR Quality Seal Level 2 are fulfilled. In our institution (Oncology Institute Prof. Dr. Ion Chiricuta) more than 300000 chemotherapy cycles were already administered using this software. The program is also used in eight county hospitals or private centres in Romania. A customized version was recently created for use in the veterinary medicine (cats and dogs).

Conclusions: The presented solution, a robust software program makes the administration of chemotherapy safer, avoiding calculation errors, offering instant access to patient’s history, as well as to a vast and updated protocol library. It shortens the time, standardizes the process and reduces the workload related to chemotherapy. The software can provide to the health authorities real-time data related to the number of cancer patients treated, the indications and the amount of drugs used. Its veterinary version can help the development of a veterinary medical oncology network. The data from this software may be used for prediction of stocks in pharmacy. The chemotherapy protocol library with browsing and help system attached provides a basis for an e-learning system in oncology.

Keywords: Chemotherapy software, human chemotherapy, veterinary chemotherapy.

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Nicolae TODOR, Mihai BORZAN, Laura Elisabeta CIULEANU, Dana Ioana IANCU, Voichita Alexandra GHENGHEA, Tudor Eliade CIULEANU,, Development and Evaluation of a Software-based Clinical Pharmacography System, Studies in Informatics and Control, ISSN 1220-1766, vol. 24 (4), pp. 427-438, 2015.

  1. Introduction

Medical oncology is one of the most dynamic areas of contemporary medicine. In addition to standard chemotherapy and hormonal therapy, medical oncology currently includes molecular targeted therapy (monoclonal antibodies, protein kinase and immune checkpoint inhibitors) and supportive care (erythropoiesis stimulating agents, growth factors, osteoclast inhibitors, antiemetics, analgesics). The large set of products and possible combinations require a computerised infrastructure for individual, institutional, regional or national use. Some of the pharmaceutical companies provide for their specific products nomograms or developed programs that help the physician in using these molecules to avoid toxicity. Various patents offer different prescribing solutions [1], such as: JP2004362336(A) “Cancer chemotherapy execution support system” JP2007293906(A) “Cancer chemotherapy management system“, US2006/0031100AI “Method of providing per dose delivery of veterinary oncology chemotherapy and immunotherapy agents and nutritional formulations”. Some leading companies or cancer centers have created their own utilities such as ARIA product by VARIAN or the IntrinsiQ program, of Miami University [1]. Since 2007, the software application, IntelliDose, permitted the registration of 17000 patients each month. This data base is the foundation of products and services with multiple beneficiaries: it facilitates the activity of the treating physician (oncologist) and clinical pharmacist, eliminating the human error in chemotherapy dosing and scheduling, facilitates the decisions of the hospital manager, and is useful to the market researcher and the financial analyst. Despite a major request, there are few global solutions developed, even for human oncology, and almost completely lacking in veterinary oncology.

In Romania, the prescription of chemotherapy is still done manually, without using a computerised system, and the chemotherapy doses are individually calculated by the oncology physicians, for each patient, using published chemotherapy protocols and nomograms for body surface calculation. This process is time consuming and leaves the space for human error. The electronic prescription recently introduced in Romania by the health authorities does not cover the complexity of chemotherapy protocols calculation in an individual patient.

In order to achieve high quality standards for the medical oncology department, the Oncology Institute “Prof. Dr. Ion Chiricuţă” Cluj-Napoca (IOCN) created, since 1997, a pharmacography software for medical oncology, that was periodically updated, with the last update in 2014 [1]. The protocol library was extended to include new chapters such as molecular targeted therapy and immune oncology.

At present, the database includes 800 chemotherapy protocols and over 300,000 cycles administered to patients between 1997 to 2015. Because of its practical advantages and friendly use, the solution is currently implemented in other cancer services in Cluj (Department of Radiology of the Medical County Hospital and Medisprof Clinic) and in some other county cancer cent (Alba-Iulia, Baia-Mare, Deva, Oradea, Sibiu, Târgu-Mureş,).

Recently, the program was adapted also for use in veterinary medicine, a unique solution for Romania until now. The veterinary knowledge data base includes 50 protocols for the chemotherapy treatment in pets (dogs and cats).

The 2014 update includes four versions (i.e. for humans or pets and standalone or network).


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