Development Of a New Regimen Function For Cancer Chemotherapy With a Computerized Physician Order Entry System Aimed At Reducing The Burden On Doctors In Japan

Physician overwork has long been a problem in Japanese society. Mean weekly working durations are reportedly 70.6 hours. The working hours of hematologists are estimated to be especially long. In addition, there is no payment system for specialist medical care in Japan and there is no difference in payments for treatment between specialists and general physicians. The average hourly wage is $30 for both specialists and general physicians in Japan, while the respective values are $100 and $70 in the United States. Given this situation, we advocate that working hours of Japanese hematologists be reduced by improving their work efficiency. One of the problems lies in dose calculations for anticancer drugs. With the conventional ordering system, the method of rounding the dose fractions varies among physicians and there is a potential risk of incorrect administration. We developed an anticancer drug administration system designed to reduce hematologists’ workloads and improve the appropriateness of anticancer drug dosing. We then examined its efficacy.

EGMAIN-GX (Fujitsu Ltd., Japan) version 2 is an electronic medical record system incorporating an ordering function. We developed a drug administration system named Regimen version 4 in order to update the EGMAIN-GX version 2 ordering system. The new system allows dose calculation with a rounding function in which the dose is automatically rounded off to the nearest whole number. Seven hematologists were asked to order five regimens (IDR/araC, Flu/ivBU, R-CHOP, hyper-CVAD, R-ESAHP）for a patient (165 cm in height and weighing 52 kg) using the new and old systems. Times required for ordering and prescribed doses of anticancer drugs were compared between the two systems. Statistical analysis was performed using Student’s t test.

The mean time and standard deviation (seconds) for ordering are shown in Table 1.

The time was significantly reduced with version 4 as compared to version 2, except for R-CHOP. The cumulative time was reduced by 54% with version 4. As to the prescribed doses of anticancer drugs, significant differences between the two systems were found in busulfan (42.0 mg vs. 40.7 mg, p < 0.0001; figures rounded off to the nearest whole number in the present system, i.e., 42.0 mg) and rituximab (529 mg vs. 583 mg, p= 0.002; figures rounded down to the nearest 100 in the present system, i.e., 500 mg).

The new drug administration system significantly reduced the time required for ordering and facilitated appropriate anticancer drug dosing. These results show that the new drug administration system can reduce hematologists’ workloads and also reduce the risk of incorrect administration of anticancer drugs.

No relevant conflicts of interest to declare.