The Organ Transplant Tracking Registry (OTTR) is the IT solution implemented by the Multi-Organ Transplant Program at the University Health Network for the management and follow-up of transplant patients. The increase in prevalence of many chronic diseases susceptible to be treated – and in many cases, cured – by organ transplantation, and the improvement in survival rates achieved by better immunosuppressive therapy led to mounting numbers of patients that needed to be followed by the program. Not surprisingly, paper based methods became inefficient, and a technology-based solution was sought. Eleven years after its initial implementation, OTTR has proved to be a resounding success among care providers in the Multi-Organ Transplant Program thanks to a well executed system analysis and design process. The following discussion about the specifics of this process was elaborated by integrating the experience of technology specialists, care providers, and research personnel, who provided a 360 degrees view of the scope of the system.
Before the OTTR system was in operation patient information was recorded using hand-drawn spreadsheets. The need for a computer-based solution became apparent because of improvements in surgical techniques and immune-suppressant drugs translated into higher survival rates. There was a dramatic increase in the number of patients being followed by the transplant program (Levy, 2012). Manual data collection became time-consuming, hard to retrieve, prone to errors and insufficient to meet health care demands. Patient care was being negatively impacted and UHN decided it was time to begin developing a technology-based solution.
Given the budget of the project it was decided that a software solution would be purchased and no custom built software would be built. The team expended significant effort evaluating different software solutions and select the vendor carefully to ensure the system would meet the needs of the end-user.
A project milestone schedule was developed (Appendix B). The vendor and software review began in 1998, was selected in March 1999, was tested in September 1999, and went live in January 2000.
A heavy emphasis was placed on knowing the end user and understanding their needs so what was implemented would be adopted and improve efficiency. The project was very successful, focused on the end-user from day-one, and this was a major contributing factor to the overall acceptance.
System Requirements and Technology Summary
This section will briefly discuss the most important system requirements for the OTTR system. Many of these technology features are related to reliability, security, health care standards, and end user usability requirements.
The OTTR solution had a number of security and privacy requirements that were essential and non-negotiable during the software selection and implementation phases:
The OTTR system had to be robust and built on a solid technology foundation. Because the system was primarily a health information system is had to be built on robust database technology.
Health care demands high availability, high reliability, and unprecedented safety. The OTTR system had very high security and reliability design requirements that are typical for any health care system in Canada.
OTTR did not exist as an island and it became a powerful system when it was able to collaborate and communicate with other health care systems at UHN using health data standards and middleware.
The OTTR system has a long and successful history spanning over 10 years. However, as any other system, there are limitations to its performance. These include the following:
Because of the age of the system, the user interface is beginning to show its age and has become dated and no longer adheres to the current user interface standards for health care software. An updated user interface would make the application more user-friend and enhance the user experience, which would improve overall productivity and reduce the training costs.