Saving Lives: Informatics and Technology in Organ Donation

Purpose: Technological advances continue to affect health care in countless ways, and informatics specialists have emerged as a critical bridge between technology and clinical practice. Our purpose is to demonstrate ways in which meaningful use can be achieved when informatics specialists partner with organ procurement organizations (OPOs) to apply informatics solutions to challenges in referring, managing, and documenting the organ donation process. Beyond the capacity for meaningful analytics resulting from advanced tracking and documentation tools, those specialists can provide insight and leadership to increase efficiency.

Description: The Centers for Medicare/Medicaid Services (CMS) oversees organ donation in the United States by administering part of the National Organ Transplant Act (1984) that organizes organ donation by requiring partnership between hospitals and organ procurement organizations. Conditions of participation (COPs) issued by CMS require hospitals to make timely referral of any patient death or imminent death to their OPO to preserve the option for donation (1986). (Note that hospitals sharing patient information when making a referral is a protected consultation because OPOs are HIPAA-exempt. Pathways that link hospital electronic health records (EHR) to the OPO via the OPO EHR provider mean that required demographic and clinical data can be transmitted electronically instead of tying up a clinician on a telephone call.

We sought to build the electronic pathway from hospital to OPO to eliminate phone calls but still obtain vital information to protect the option for organ donation and remain timely. Hospital staff, often nurses in busy emergency or intensive care units, can spend ten or more minutes on the telephone provided demographic and clinical details about the referred potential donor, virtually all of which is contained within the patient’s EMR. Since OPOs are bound to the same security and privacy requirements as hospitals, we believed a secure pathway could be built to recognize certain fields or elements within the patient EMR and electronically notify the OPO when a threshold of clinical triggers was met. This not only would eliminate the clinician’s time on the phone but would also ensure accurate transmittal of required data to the OPO so they could organize the correct response. With more than 100,000 people on the US waiting list for a transplant, these referrals are the lifesaving bridge for those patients. We tapped informatics leaders to serve as champions between information technology (including system security) and clinicians to identify required data fields, build the pathways or reports that would prompt an electronic notification to the OPO, and quality check output.

Evaluation/outcome: A pilot hospital committed to the concept, and their informatics team identified subject matter experts (SME) from the EMR provider. The OPO and SME from their EMR provider joined to explain the vision, required data fields, technical pathways, and expected results. The teams met weekly throughout the project and began coding the pathway between hospital and OPO so that a new referral would appear in the OPO’s EMR platform with prompts alerting them of an urgent notification. The OPO’s remote access to the hospital EMR allowed OPO experts to review the EHR in real time, eliminating protracted phone call time for nurses or other providers. While some follow-up phone calls are required to clarify or obtain additional information, they are briefer and more focused.

Conclusion/implications: There has been a significant push to increase organ donation and transplantation in the last few years, and some have suggested that CMS should classify missed or late referrals as sentinel events. The urgency of potential organ donor referrals is associated with life or death for patients needing an organ transplant. Automated electronic referrals are an informatics solution that reduces inefficient phone calls, improves accurate clinical data transmission, and saves lives by ensuring the option for organ donation is protested and prioritized. The hospital/OPO pilot project has seen automatic referrals reach 87% timely and accurate, verified by manual review of the EHR. Expansion of automated electronic referrals can save thousands of hours of provider time and remove subjectivity from a critically important consultation from the OPO.