Sydney Adventist Hospital uses AI to Increase Cancer Multidisciplinary Meetings Efficiency

Sydney, NSW, (June 12, 2020) – Sydney Adventist Hospital (The San) is now using Artificial Intelligence to automatically populate their cancer Multidisciplinary Team meeting system with pathology information using Natural Language Processing from local company Health Language Analytics (HLA).

The San uses HLA’s CliniSearch application to identify relevant data from a pathology HL7 feed provided by Douglass Hanly Moir (DHM) for the San’s cancer patients. The pathology information is used to automatically pre-populate the correct data fields in preparation for the various cancer Multidisciplinary Team (MDT) meetings run at the San.

Associate Professor Gavin Marx, Director of the Integrated Cancer Centre at the San, sees this as a real advantage for the clinical team and patient care processes. “Pathology is a key component of cancer MDT meetings and there is a significant amount of data generated from each pathology report”, he emphasised. “To have the ability to automatically extract and use this data in a structured format in the context of other available information for clinical decision-making at the meeting saves us a significant amount of time and effort, and enables us to use the data for research purposes”, he explained.

To give a sense of the clinical staff time saved in preparation for an MDT meeting and increased data availability at the meeting at the San, there are sixteen different pathology templates currently included in the extraction service as a joint effort by the San, DHM and HLA. The sixteen reports contain a total of 616 data fields, all of which are identified, extracted from the reports and then coded to SNOMED CT using natural language processing before being fed into the MDT system for presentation at a patient discussion. This is now fully automated, uses no critical staff time and prevents manual transcription errors.

The following table presents the current data extraction volumes:

Tumour StreamTemplateNo. of Fields
BreastBreast Carcinoma61
Breast Carcinoma Post-Neoadjuvant Therapy67
Biomarkers15
LungLung Carcinoma41
UrologyProstate Biopsy23
Radical Prostatectomy54
Prostate TURP18
Bladder Cystectomy32
Renal Pelvis & Ureter34
Renal Cell Nephrectomy40
Renal Cell Partial Nephrectomy33
Testis27
Gynae-OncologyCervical Carcinoma42
Hysterectomy45
Ovaries, Fallopian Tubes, or Peritoneum39
Vulval Carcinoma45
TOTALs16616

Professor Warick Delprado, Director of Histopathology at DHM, highlighted the value of this collaboration, “This is a valuable initiative, allowing us to work in partnership on a project that has mutual benefits for the San and all patients, as well as enhancing the efficiency of our pathologists to continue to deliver high quality service for the Multi-Disciplinary teams”.

The San’s CliniSearch application runs on the Horizon technology platform from HLA and currently has over two million reports indexed for a wide range of clinical concepts. All the pathology reports’ free text sections have been coded to SNOMED CT. By automatically indexing, unpacking and coding the pathology reports from DHM, HLA’s AI is able to fill in the pathology data fields in the newly implemented Multidisciplinary Team meeting system, so that each patient discussion is as fully informed as possible.  With the MDT meetings being moved online due to COVID-19, this ensures that all relevant pathology information is available to all participants remotely, and a high level of patient care is still available.

Professor Jon Patrick, CEO and co-founder of HLA said, “we are pleased to work with the San and DHM by adding AI-based natural language processing to their MDT data workflows. This has reduced admin time and improved accuracy while giving far greater depth to the pathology information available at each MDT meeting”.

ICIMS roll-out to MDT streams continues

Meanwhile, the Sydney Adventist Hospital’s Integrated Cancer Centre had quickly responded to the COVID-19 crisis by moving its MDT meetings onto a remote footing. The Integrated Cancer Information Management System (ICIMS) commenced implementation in June 2019, thanks to a generous donation by the San Foundation. Since then, the San has brought the Lung and Breast tumour streams online, and more recently, the Urology and Gynaecological Oncology modules went live and were launched remotely due to the COVID-19 crisis.

The remote set-up enables cancer case-viewing and treatment-planning on a centralised patient cancer record during the online meetings with Surgeons, Medical Oncologists, Radiation Oncologist, Pathologists, Radiologists, Nurses and Allied Health Services, who may be working from premises all across Sydney.

“The transition to online MDT registrations for our prostate patients has been seamless and very important especially during the COVID crisis. Having the ability to see the surgical and pathological data automatically available in the system has been vital to our MDT discussions” emphasised prominent urologist Professor Henry Woo.

Another immediate benefit of ICIMS is that pathologists and radiologists involved in the MDT now get access to the patient lists and required reviews in real-time. Previously a batch process the day before the meeting often left them needing to work late into the night to compile the required data in time for the meeting. In addition, the data are now automatically populated in ICIMS as soon as a pathology report for a San patient is authorised by the pathologist. These abilities also significantly reduce the workload on the MDT meeting coordinator while increasing data richness and accuracy at the meeting.

The ICIMS solution presents the same functionality to each user whether they are working in a combined conference room or logging in remotely. This means that no user retraining is needed and each patient receives the full benefit of the multidisciplinary team no matter where each team member is located.

iCIMS (Innovative Clinical Information Management Systems)has been recently granted a patent for its LATTICE technology platform by the United States Patent and Trade Mark Office.

See PULSE+IT article here.

iCIMS Technology Awarded Patent by the United States Patent and Trademark Office

iCIMS is pleased to announce that it has been granted a US patent for the technology underlying its award-winning software platform LATTICE.

This comes on the heels of iCIMS being announced as the inaugural winner of the Medical Software Industry Association (MSIA) Best Innovation by a Member Company 2019. See article here.

iCIMS won the award for its implementation of a LATTICE powered solution for the Sydney Adventist Hospital’s Cancer Centre of Excellence that enabled automation of the various multidisciplinary team meetings that form part of the core offering in the San’s fight against cancer.

The power of the LATTICE technology was demonstrated with a seamless move to remote team collaboration due to the CoVid-19 crisis. Ali Besiso, iCIMS’ Managing Director was pleased with the result, “For one of our major clients to be able to bring a new tumour stream online, and do it remotely, during this crisis shows the power of our infrastructure and its unique way of very quickly building and deploying clinical systems, a uniqueness that has been acknowledged by the recent granting of a Patent for our technology by the United States Patent and Trade Mark Office.”

iCIMS Wins Inaugural Innovation Award from the Medical Software Industry Association

Integrated Cancer Centre

28/11/2019 – SydneyAustralian innovator Innovative Clinical Information Management Systems (iCIMS) was named the inaugural winner of the Medical Software Industry Association (MSIA) Best Innovation by a Member Company 2019 at the MSIA 2019 Summit & Annual General Meeting. The Award was presented by Robert Best – President of MSIA.

iCIMS won the award with a submission titled:

A Single System Solution with 10 Specialised Cancer Modules 

The system was designed to move clients managing a Cancer Multi-Disciplinary Team (MDT) Meeting from a multipage paper referral protocol with cumbersome manual preparation to a fully integrated, workflow-driven system that automates end-to-end processes.

iCIMS enables online access from anywhere to register patient cases and an intuitive registration process triggers auto-population of available patient data from multiple source systems in real-time for case discussion.

One client, Sydney Adventist Hospital, uses iCIMS to access seven different data systems via HL7/FHIR/APIs to centralise patient data, cutting down on time wasted manually entering data and reducing errors in data transcription. Not only does the system work with structured data, but by using cutting-edge Natural Language Processing from iCIMS’ sister company HLA-Global, the system can automatically extract and load data from unstructured Pathology text reports into the cancer case record. 

Each of the ten tumour streams (Breast, Lung, Prostate, Gynae-Oncology etc.) has a front-end tailored specifically to its data and workflow needs while the single back-end ensures hospital-wide data consistency and security.

iCIMS uses a unique business model that accords each client a three-months system grace period after go-live to request unlimited changes (free-of-charge) to maximise efficiency and User Experience (UX). This is designed to alleviate one of the biggest hurdles in software design and delivery – users don’t really know what they want until the system is in daily production.

Ali Besiso, Managing Director said, “Winning the inaugural MSIA award is a fantastic achievement for our young company, made even more special by the fact that this award is voted on by our medical software/digital health vendor peers as well as the MSIA board. The award acknowledges our platform’s impact in Cancer MDTs across a range of settings/clients, with a particular focus on the San as our main referenced use case.

This is a testament to all our clients who believed in us as a company and gave us an opportunity in a challenging industry for any young Australian company in the digital health space.”

The iCIMS solution has been implemented at The Sydney Adventist Hospital thanks to the kind donation of the San Foundation.It is also implemented at St. George Hospital in Sydney and The Parkville Precinct in Melbourne which includes the Royal Melbourne Hospital, Peter McCallum Cancer Centre and The Royal Women’s Hospital.

Sydney Adventist Hospital Implements iCIMS across its Integrated Cancer Centre

Sydney Adventist Hospital’s MDT Room

Sydney, NSW, (June 19, 2019) – The Sydney Adventist Hospital (also known as ‘The San’), is working with technology partner Innovative Clinical Information Management Systems (iCIMS), to fully automate its Cancer Services Multi-disciplinary Team Meetings (MDTs). The new Integrated Cancer Information Management System (ICIMS), built on iCIMS’ LATTICE platform, will enable the San’s Integrated Cancer Centre to reach its full potential by streamlining and automating data preparation, data collection and workflows for each of its 10 tumour stream MDTs. This project comes as the San continues to advance its Cancer ‘Centre of Excellence’, including its state of the art Multi-Disciplinary meeting room, towards becoming the leading cancer service in Australia.

ICIMS creates a closed-loop cancer MDT management system which will increase patient safety and service while significantly reducing the work load on clinicians. The implementation includes a minimum of 8 integration points with the San’s electronic clinical systems, including the SanCare EMR for clinical details, the San’s PAS for patient demographics, Operating Theatres for surgical data, Pathology for targeted cancer data, Day Infusion Centre system for systemic therapy data, and the Radiation-Oncology database for radiotherapy data. ICIMS enables automatic delivery of all critical patient data to present the full patient story in a single patient-centric view at the MDT meeting. Preparation time and effort by clinical and ancillary staff is significantly reduced, data collection is comprehensive, and decision-making is thus better informed.

“This is an important and exciting collaboration between the San and iCIMS” said Associate Professor Gavin Marx, Clinical Director of the San Integrated Cancer Centre. “The accelerating pace of improving care and treatment of our patients at the San is founded on complex multidisciplinary collaboration – through efficient access to all the critical information we need for care planning and driving ongoing research. Our ICIMS is the bedrock for reliable collection, analysis and presentation of big data information for our multidisciplinary teams”, he added.

The system will drive a universal streamlined referral process across tumour streams so that MDT clinicians can electronically refer and register patients to MDT meetings from anywhere, including remotely. A further efficiency and productivity boost is that pathologists, radiologists, nuclear medicine specialists, and other diagnostic specialists can easily access the system at any time leading up to an MDT meeting to prepare their cases pro-actively and at their own convenience.

During an MDT meeting, ICIMS generates clinical summaries auto-populated with all available clinical information required for case discussion. Treatment recommendations are recorded in real-time on the system for follow-up and actioning. Finally, The MDT summaries from each meeting are immediately sent electronically into the hospital’s EMR enabling easy access for clinicians, distribution to others involved in the patient’s care, monitoring of the patient journey and timely follow up, so closing the information and action-taking loops.

The project, was developed in consultation with the MDT clinicians, with user-group workshops and agile design, and the breast and lung tumour streams are set to go-live this month.

Chris Williams, San CIO, said “It is fantastic to be working with innovative Australian companies iCIMS and HLA. They have both the local and international experience in oncology and MDT systems together with expertise in clinical Natural Language Processing environments. The ICIMS application, supported by CliniSearch’s NLP extraction pipeline, interfaces to just about all of the Hospital’s key systems, including our EMR. This provides us with a strong platform to underpin quality care and treatment at the San for now and into the future”.

Pathology Feed

The San has also taken a world-leading initiative to provide the Pathology feed into ICIMS via Health Language Analytics’ award-winning HORIZON CliniSearch platform. HORIZON’s Clinical Natural Language Processing (NLP) extracts targeted cancer content in prose pathology reports and sends it to ICIMS to populate the structured pathology data items of an MDT case. CliniSearch has been implemented at the San for some years and currently contains over two million fully indexed and coded clinical reports in its data store, which now will be connected to ICIMS. Professor Jon Patrick, leading the NLP branch of the project, said that this is a ground-breaking advance in bringing an industrial-grade NLP pipeline to the front and centre of clinical workflow. 

As well as managing patients in an MDT environment, the system facilitates research, auditing, and automated reporting to such organisations as Hospital Operations for analytics, the Royal Australasian College of Surgeons for data collection, Cancer Institutes for MDT statistics, and the NSW Cancer Registry for case recording and clinical details.

“We are excited to be working on such a large-scale leading-edge project with an organisation as ambitious and innovative as the San. Our platform gave the San the ability to install a solution that is tailored to their vision, achieving the goals of their clinicians, administrators, and IT custodians”, said iCIMS Managing Director, Ali Besiso. “The ability to provide tailored modules for each of the 10 tumour streams, all within a single solution architecture achieves the best of both worlds of enterprise and best-of-breed solutions” he added.

Sydney Adventist Hospital known affectionately as the San since it started in 1903 as a Sanitarium is NSW’s largest private hospital, a not-for-profit healthcare organisation of the South Pacific Division of the Seventh-day Adventist Church. It has over 700 beds including 524 overnight beds with over 2,400 staff, 500 volunteers and 1,100 accredited medical practitioners caring for more than 63,000 inpatients and 120,000 outpatients annually – delivering 1,800 babies and treating 18,000 presentations to Emergency Care.

It is a teaching hospital of the University of Sydney and a partner in nursing education with Avondale College of Higher Education. It provides comprehensive acute surgical, medical and obstetric care including a large range of diagnostic, allied health, and support services, was the first private hospital in NSW to offer Radiotherapy services in 1977, and the first hospital in Australia to offer a private, fully integrated cardiac surgery and catheterisation program in 1979.

iCIMS expands oncology MDM solution to Peter MacCullum, St George Hospital

iCIMS expands in Victoria and NSW with its Oncology MDM solution

Following on from the successful implementation of Melbourne Health’s Clinical & Research Information Management System used by the shared Breast Cancer service of The Royal Melbourne and The Royal Women’s Hospitals, the solution will be extended to the breast cancer patients of the Peter MacCallum Cancer Centre.

The Innovative Clinical Information Management Systems (iCIMS) installation is designed to allow easy access from all institutions within the Parkville precinct. The system – known as RUTH II – enables the three hospitals to track the patient journey, manage the Multidisciplinary Meetings (MDMs) and transparently share patient information.

iCIMS Product Development Director Ali Besiso said iCIMS used its advanced technology to enable a concept it calls Immediate Adaptability to very quickly prototype a system tailored specifically to the needs, workflows and outcomes required by the three hospitals. One example of this was the additional need for the PMCC solution to integrate with VERDI’s Clinical Viewer.

A facet of Immediate Adaptability that sets iCIMS developed systems apart is the speed of user-driven system design changes. This speed, in turn, allows iCIMS to deploy a unique installation model; once the initial handover is completed, the client has three months to request system design changes without additional cost.  The result is a highly tailored, fit for purpose solution that has overwhelmingly high user buy-in from senior clinicians, nurses, data administration and ancillary services.

Mr Besiso explained that as an example of the immediacy of changes, with the original RUTH II system that was installed into Melbourne Health, there were 98 design changes requested by the clinical users as a result of them using the system in a live environment in the first three months. Of those changes, 93 were delivered with an average turnaround time of 3 days without any system downtime. The remaining 5 changes required deeper engineering changes and took longer.

Professor Bruce Mann –   Director of Breast Tumour Stream, Victorian Comprehensive Cancer Centre (VCCC) has seen the effects of iCIMS’ Immediate Adaptability within his team; the members of the multi-disciplinary team have been impressed that changes suggested during a live MDM have been implemented and operational the following week.

RUTH II is integrated with the hospitals’ Patient Administration Systems (PAS) including HL7 A40 merge messages updating patients’ medical record number to the new Precinct Unique Record Number (PURN) shared across all three hospitals (including the Peter MacCallum Cancer Centre where the joint weekly Multi-Disciplinary Team Meetings takes place).

The integration, coupled with iCIMS’ workflow engine, reduces cognitive load, lowers ‘click fatigue’ and increases accuracy by prefilling form entries from the PAS and from patient clinical details held within RUTH II. This functionality increases accuracy and reduces the time taken by staff to enter data and prepare for Multidisciplinary Team Meetings. Current estimates put a saving of around 30% of data entry time using RUTH II vs the previous system. Time that is now available to manage an increased number of patients without additional workforce.

As well as the core functionality, the system has additional modules that produce:

  • End of treatment summaries and outcomes
  • A survivorship component that generates Survivorship Care Plans.
  • Breast audit data exports

RUTH II has been designed to be fully expandable into other tumour streams and other sites within the Parkville precinct.

Further north, in NSW, St. George Hospital Breast Cancer has also gone live.  The back-office functions have been running since 22nd of September, and a full go-live of the MDM occurred on October 4th.  The successful go-live followed a lot of preparation work on Phase 1 of data migration, importing data from a pre-existing ACCESS database.  This was done to satisfy the project aim to preserve historical data and combine that with new data for research and audits.

St. George’s Breast Cancer installation expands on the existing iCIMS infrastructure at the hospital complex.  The infrastructure has been supporting the MDM processes for Australia’s largest Peritonectomy practice and went live in November 2016.