Background

We worked directly with a team of dermatologists from University Hospitals in Cleveland, one of the 32 leading cancer centers in the National Comprehensive Cancer Network. The dermatology experts we worked with are dedicated to provide comprehensive treatments for the most serious type of skin cancer – melanoma.

For years, they have faced the difficulty in uniting the divergent medical record systems and tumor board documentations. And they want to have a tool that could unite the melanoma decisions and outcomes for the 32 cancer centers.

[client from University Hospitals]

[problem]

Divergent medical record systems and tumor board documentations

Understanding the Problem

To understand what our client meant by “divergent medical data”, we first interviewed stakeholders who interact with these data. We used interview methods and framed questions in a way that brought them to their real life working context and re-experience the problem. The stakeholders we talked to include: 1 tumor board coordinator who prepares and gathers data for tumor boards, 3 specialists who attend the tumor board meetings, 1 technologist who manages the systems used by the doctors, and 3 researchers who would like to know the results of tumor boards.

1 x tumor board coordinator
(prepare and gather data)

3 x specialists
(attend tumor boards)

1 x technologist
(manage medical system)

3 x researchers
(use tumor boards data)

We uncovered 3 reasons of why medical data is scattered and divergent:

[a]

Data within electronic health record (EHR) comes in different sources and formats

[b]

Accessing data is made difficult by healthcare privacy policies

[c]

Centers have different tumor board practices, including discussions and documentation

Initial solution

At this point, a potential solution seemed clear – creating a single digital system that streamlines local tumor board documentation and workflow. And by achieving standardization in a local setting, the same process can be adopted at other cancer centers to facilitate future data unification.

Hurdle

After we decided on the data-standardized system and its potential features, we pitched it to our client. They expressed their excitement and shared our solution with other stakeholders. Then, an unexpected stakeholder called out NAVIFY.

NAVIFY is an online platform that aims at facilitating the tumor board process. It has the ability to integrate with any EHR, making it accessible across departments and eliminating the effort required for data entry and exports. After I reached out and talked to the 3 specialists who worked there and the executive representative, I soon realized that NAVIFY does (partially) what we ideated. It does not do everything, but well enough. Like the executive representative asked during our conversation: “Why not use us?”

Adjusted solution

The 2.5-month research led our team back to the very beginning, but we pulled ourselves up by the bootstraps and generated potential paths to pursue. During our conversation with the client, we found out what our client really wanted was the structured database itself. They were eagerly looking for a database that makes it easy to store and extract patient data to create a research registry.

A new path & understanding current workflow

With the newly set goal of transforming clinical melanoma tumor board documentation into research-ready data, we investigated the University Hospitals workflow. We specifically looked into the workflows of tumor board coordinators and researchers as they are the 2 main stakeholders. Since both of them work with privacy-sensitive patient data, we crafted 2 creative methods to hone down on what the workflows looked like. We named them: simulated environment observation and real-life diary checkins. With these two approaches, we were able to obtain the most accurate workflow and learn how to create the best value for them.

We observed 2 processes related to clinical melanoma data are occurring:

[a]

Tumor board report preparation

[b]

Data extraction for research

[a] systems a tumor board coordinator goes through

[b] systems a research goes through

These two processes both consist of someone digging through multiple hospital digital systems, including Electronic Health Record, department-specific software, and Google Drive, to gather relevant data. Informed by our client, there is also an overlap in the data for tumor boards and the data needed for research. Thus, we speculate that it is possible to consolidate the two efforts into a single database — what we are calling, the MELAbase.

[ Before ]

[ After ]

Final solution — MELAbase

MELAbase – a system simplifies the tumor board reporting process and creates research ready data.

Forms that follow your mental model.

Say goodbye to reports with unclear hierarchy and groupings. MELA provides tumor board report template that is informed by physicians, saving you tremendous time to fill and read through.

Autofill data fields
with only clicks.

Make reports with clicks, no more long free texts. Some data fields are even auto-generated by previous-entered info.

Powerful searching.

Our careful breakdown of data allows researchers to quickly extract relevant data. With MELAbase, no need to keep your old-fashioned way of digging through numerous reports to find just one piece of information. Use the search bar, apply customized filters, and find what you want.

Patient list page

On the patient list, you can add a new patient, access patient data, or use the search bar to filter through cases.

Individual patient data page

View each patient's documentation with this new layout. The carefully designed hierarchy and clean display of information makes you read efficiently and effectively.

Tumor board page

On the tumor board page, you can arrange the patient list to be presented at the upcoming tumor board, or view previous tumor board meetings.

Demos

Tumor board coordinator demo

Melanoma researcher demo

Back to work

pinyangl@stanford.edu