OTWonco: Oncology Care Management and Clinical Decision Support Platform

Oncology is the branch of medicine related to the prevention, diagnosis, and treatment of cancer. Cancer is a generic term given to a set of more than 100 different diseases characterized by the abnormal growth of “damaged” cells in a region of the body, leading to the formation of a tumor, a compact mass made up of these damaged cells. Tumors can be cancerous or non-cancerous (benign) and may or may not spread throughout a person’s body. Cancer is one of the leading causes of death worldwide, and it is estimated that annual figures could reach nearly 30 million new cases and 17 million deaths by 2040 [https://gco.iarc.fr/].

Various healthcare professionals are involved in the management of a patient’s oncology care. Starting with a medical professional specializing in Oncology, the Oncologist, but oncology care also involves other professionals with backgrounds in Nursing, Pharmacy, Nutrition, Psychology, as well as other physicians such as Surgeons, Gynecologists, Neurologists, among others. It’s important to note that in oncology treatment and monitoring, all of these professionals play a significant role, as patients face prolonged treatments, side effects, changes in routine, self-esteem issues, and the experience of confronting end-of-life situations.

The significant importance of healthcare professionals in the care of oncology patients is undeniable. However, technology tools complement the human component to enable the recording and storage of diagnoses, classification and staging of tumors, registration of tumor markers and biological data, medical histories, treatments, progress notes, vital signs, toxicities, tests, treatment protocols, surgeries, palliative care, chemotherapy prescriptions, among many other components that constitute oncology patient care.

The OTWonco is an Oncology Care Management and Clinical Decision Support Platform that has been in use and continuously improved since 2010 by the technology team at the Cancer Combat Center, which transformed into OTAWA Health through a spin-off in 2019. Diletta Solutions joined the project to restructure OTWonco from its original client-server environment to a Cloud-Based environment.

The new OTWonco is built upon basic premises including the utilization of the international model and standard for health data construction and storage called FHIR HL7, and information security adopting the HIPAA – Health Insurance Portability and Accountability Act, a set of stringent regulations established in the USA to safeguard health information. HIPAA focuses on confidentiality, integrity, and availability of protected health information. Being compliant with HIPAA also means being compliant with the national LGPD – Lei Geral de Proteção de Dados (General Data Protection Law).

In addition to health data modeling (FHIR HL7) and information security (HIPAA), understanding and comprehending the stages involving cancer diagnosis, monitoring, and treatment, and developing a scalable, agile, user-friendly platform with customized access interfaces for various healthcare professionals were other premises defined in the project’s conception.

The OTWonco accommodates multidisciplinary care specifically tailored for oncology treatment, represented in electronic medical records, questionnaires, and care pathways for physicians, nursing, pharmacy, nutrition, and psychology. It offers over 20 types of monitoring for recording oncology care, such as Diagnosis, Staging, Histological Grade, Tumor and Biological Markers, Medical History, Treatment Approach, Vital Signs, Toxicity, Nursing Diagnosis/History/Follow-up, Pharmaceutical Care, Nutritional Intervention, Psychological Assessment/Evolution/Approach/Distress, Patient Education, Chemotherapy Planning and Scheduling, among others.

The Clinical Decision Support component is perhaps the primary and significant differentiator of OTWonco. Based on structured information records related to a patient’s diagnosis, OTWonco enables precision medicine by conducting an extensive and complex combinatorial analysis to suggest to the oncologist which, among the approximately 400 treatment protocols stored in OTWonco, are most suitable for the patient’s treatment.

It’s important to highlight that the entire development, maintenance, and expansion effort of OTWonco is consistently grounded in the essential participation of a multidisciplinary team – individuals who genuinely understand the functionalities that truly matter for the management of their clinical practices. It is the involvement of these professionals that empowers OTWonco to be a practical, useful, and fully aligned tool for managing oncology care.


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