Ordering chemo by computer
As part of ongoing patient-safety efforts, pharmacy technician Nathan Spencer scans medication bar codes for entry into the department's drug dictionary as colleague Cristiane Cunha passes by.
When Garber and his family arrive in the infusion unit, a few features of his regimen have not been ordered electronically: the kiss planted on his cheek by his infusion nurse Lynn Colicchio, RN, and their discussion about making potato pancakes. Other than that, his order has been placed through the Chemotherapy Order Entry (COE), a Partners system that grew from Brigham and Women's Hospital's physician order entry tool, and is now used by Dana-Farber for both pediatric and adult care.
Work began as early as 1992 for this program designed specifically for chemotherapy, with very different rules from those used to request items like antibiotics. In addition to eliminating handwriting, standardization is one of the system's greatest advantages.
"COE tailors the available drugs to each type of cancer and shows how much of each should be taken, says MacLean, director of Clinical Information Systems. "For example, if you are ordering chemotherapy for a breast cancer patient, you have only breast cancer agents available to you. If it's a research study, you can't request anything that's not included in the protocol. You adjust for the person's height and weight, and if you try to order something unusual, or the dose is not right, the system will beep."
Shulman points out that COE supports oncology's need for precision. "The illnesses we see are often life-threatening, and making the right medication decision can mean the difference between surviving and not," he says. "Also, drug orders are done within a narrow therapeutic window. You have to prescribe a dose that is strong enough to kill the cancer, but not so strong as to be prohibitively toxic."
