OTTR Best Practices

1. OTTR Best Practices OUI User Conference September 2013 Confidential and Proprietary

2. Challenge OTTR must provide functionality to drive the processes of a solid organ transplant center so that all regulatory mandated data is gathered in a standard way and is easily reportable.

3. Observation Twenty years ago, transplant was, “the wild west” with each transplant center creating their own pathways and processes. In the current era transplant is a highly regulated and standardized system with national (and international) coordination.

4. Rationale Transplant Centers are responsible for reporting specific data about a patients progress. This required data does NOT vary from center to center. It must be reported by each center and it must be reported in the same way.

5. Background Each piece of transplant data has a logical place in the process that it should reasonably be gathered. If it gathered at that point and placed in the “right place” in the system all other reporting can be automated. If it is not gathered at that point in the process, later “rework” will be required to capture it.

6. Central Argument • The OTTR system should drive the collection of transplant data. • To be cost effective OTTR should do this in a common way across transplant centers. • To drive collection will require “rules”. • The specification of these roles requires a documented “best practice” of how to use OTTR.

7. Creation of the Best Practice • The best creators of a Best Practice document are team members who work at OTTR and who have experience working as transplant coordinators. • The best key reviewers of the best practice are leaders in the transplant community who have seen multiple transplant centers • The best acceptance test of best practice is the OTTR user community.

8. “Required Fields” • One (nearly correct) idea: • OTTR needs to enforce “required fields” that the user is “forced” to enter

9. “Required Fields” • Challenge • Required Fields imply that the data will be available when the patient is first put in the system. • In reality, patients proceed through the process • All data is not available at first entry

10. “Required Fields” • Solution • OTTR Workflow rules must be more intelligent than “ABO is required” • They must have the format “ABO must be entered before the patient is listed”

11. “Configurable” • Challenge • Some centers will opt out of some requirements • Some teams will decide “must” is a hard stop • Some teams will decide “must” is a soft stop • Some teams will want other rules

12. “Configurable” • Response to Challenges • We MUST act • Some flexibility is incumbent on us • Too much flexibility will make the system unworkable

13. “Configurable” • Solution • OTTR Chronic Care will encode the best practice rules • Our rules will be ranked in tiers of severity • Transplant leadership can turn off rules (or make them soft warnings) one tier at a time.

14. “Configurable” • Solution • OTTR Chronic Care will encode the best practice rules • Our rules will be ranked in tiers of severity • Transplant leadership can turn off rules (or make them soft warnings) one tier at a time.

15. Status Report - Document • Best Practices Document • Exists for Kidney Transplant Referral through Post Transplant • Is being validated by selected stakeholders • Is being used as specification for additional development

16. Status Report - Software • Registry Agent – Solid Organ • Validation supported for all Forms and Organs • Data Mappings exist for Forms and Organs • Data Mappings cover all fields • Data Mappings specify where data must be collected

17. Roadmap - Software • Highlight Required Fields • OTTR will release an enhancement to mark the “Required” fields in the application • Fields will be marked if they are UNOS Tiedi form required • Fields will be marked if they are SRTR risk adjustment weighted fields

18. Roadmap - Software Screen Shot

19. Roadmap - Software • Report out missing Required Fields • OTTR is creating a solution to report out all missing required fields • This solution will allow team members and manager to monitor un-entered “required” data elements

20. Roadmap - Software • Prompt on missing Required Fields • OTTR is investigated the best solution to stop the user when a required field is passed.

21. Next Steps • Continue to rollout Registry Agent with Form Checking • Continue to Validate Best Practices (Kidney) document • Create Best Practices Documents for other Organs • Code and Release Required Field Flagging

22. Next Steps • Develop Required Field List / Reporting • Develop Required Field Application Prompts