EOS
Eos (Greek Ηώς, or Έως "dawn") is, in Greek mythology, the goddess of the dawn, who rose from 
her home at the edge of Oceanus, the Ocean that surrounds the world, to herald her brother Helios, the sun.
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Every year the lives of thousands of people are saved or transformed through organ transplantation. 
Over 16,000,000 people in the UK  have joined the Organ Donation Register (ODR) - pledging their organs for transplant. At the same time, the number on the waiting list for a life-saving organ has risen to almost 8,000 and continues to steadily increase. 

Since January 2001, 23,551 life-saving organ transplants have been made possible thanks to the generosity of donors and their families but during the same period, at least 4,500 people died waiting for a suitable organ. Around 3,000 organ transplants take place in the UK every year, but during the same period approximately 1,000 people - 3 a day - die while waiting because of the shortage of donated organs. 

There are a number of altruistic live donations each year, particularly with kidneys but most organs for transplant come from deceased donors and are associated with tragedy in the life of a family. Given the precious nature, short supply, and increasing demand, for organs it is essential that every effort is made to maximise the use of available organs to save as many lives as possible.

It is with this background in mind, the UK Government commissioned the Organ Donation Task Force (ODTF) to study organ donation and make recommendations. One of the ODTF recommendations was the use of technology to enhance the organ offering process to increase the efficiency and maximising this precious resource. 

Organ Donation & Transplantation (ODT)  the transplant arm of the National Health Service Blood & Transplant (NHSBT) special health authority, manages the organ offering process and instigated the development of an electronic system to aid organ transplantation.

Prior to the implementation of EOS, Donor Coordinators offered organs for transplant by communicating information about the donor and organs over the telephone to their counterpart Recipient Coordinators at transplant centres across the UK. 

For a multi-organ donor, the Donor Coordinator read a 8 page core donor data form (typically 120 separate fields of information) up to 20 times. Offering was a lengthy process and could take 1-5 hours including both the time to make the offer and the time allowed to receive responses on offers. 

It has long been recognised that the use of paper forms has had a number of significant issues, which impacts organ donation rates. An electronic means of recording this information at source, with the clinically trained Donor Coordinators and then electronically presenting it to the various parties involved in parallel has many advantages. It can reduce the likelihood of errors, is more efficient, and significantly improves the time taken to communicate all the relevant important information to people who need it to make clinical decisions. Steve Bell, NHSBT Organ Donation & Transplantation Regional Manager.

There are currently some 150 Donor Coordinators, growing to 250 over the coming years and 100+ Recipient Coordinators across the UK all engaged in the organ offering and transplantation process.

NHSBT commissioned global services company, Sapient, to design an electronic system for organ offering. The Electronic Organ Sytem (EOS) was developed following extensive user experience interaction with teams of Donor Coordinators, the ODT duty office and Recipient Coordinators at transplant centres to ensure it conveyed the required information and was flexible for future development. 

Our priority was to design a new system that was easy to use and delivered the maximum benefit for organ donations whilst simplifying the proceures and making the end to end process more efficient. The Sapient Fusion process (The Sapient Fusion process is a series of workshops for identifying requirements and gaining consensus with all stakeholders) was instrumental in gathering stakeholder requirements and ensuring we were all facing in the same direction. Alan McDermott, NHSBT Group IT Director

The technology choice was critical to the success of EOS because Donor Coordinators do not have accounts on computers in donor hospitals. The coordinators must be self-reliant for technology and networking. The existing Oracle National Transplant Database (NTxD) was already in place as the central repository for organ information, so EOS needed to provide a secure path to NTxD with multi-factor secure authentication and password encryption 
from remote locations and mobile workers across the UK. The EOS application servers are fully redundant and in a separate secure data centre from NTxD based around a Java 2 Enterprise Edition (J2EE) platform.

EOS uses electronic forms to record and store donor data. Information about organs available for transplantation is displayed in real time using text and images. 3G enabled laptops allow Donor Transplant Coordinators (DTCs) to work independently in intensive care units until they are ready to share 
information with the National Transplant Database via the secure NHSBT network. With improved accuracy and security, EOS speeds up the allocation process, freeing up Donor Coordinators (DTCs) to spend more time supporting donor families and caring for the donor patient. 

Donor Coordinators use secure encrypted laptops with Oracle Express Edition (XE) databases to allow them to populate a form known as the Core Donor Data Form (CDDF). This data is stored locally (offline) until the Donor Coordinator is ready to upload the data over a Virtual Private Network (VPN) link to NTxD. A Java based synchronisation scheme manages data conflicts, if any, between the central data and the local data with the clinically -trained Donor Coordinator selecting the correct data.

This offline method of gathering data for later upload and synchronisation by DTCs is crucial to the successful operation of EOS as they are often working in areas where 3G mobile signal coverage cannot be guaranteed.

It is also possible to directly access EOS online from any web-based PC using Microsoft Internet Explorer or Firefox browsers over a secure Web-VPN, with multi-factor secure authentication. This allows access from any web-enabled hospital PC  particularly important for recipient coordinators.

The data uploaded by the DTCs is used by the ODT Duty Office to identify named patient matches or notify transplant units about general offers. The Duty Office perform a matching run in NTxD where donor data is matched against stored data of people awaiting an organ to identify the best possible matches (particularly important for kidneys), and the offering sequence for general offers. Once matches are returned the Duty Office notifies organ Recipient Points of Contact (RPOC) that they should access EOS. Two offers can be made in parallel for each organ.

Yes

Yes

The EOS system yields many benefits in patient care and patient safety over the previous paper, fax and telephony based system, contributing to saving many lives per year. Here are the main areas:

The change in the process afforded by the introduction of EOS allows the duty office to make organ offers after the Donor Coordinators have uploaded information. This frees up a significant amount of the Donor Coordinators time to be spent performing high value activities such as caring for the donor 
patient and their family.

Electronic data capture at source by clinically trained Donor Coordinators eliminates transcription errors enhancing data quality, patient safety and making the process more efficient. 

Parallel organ offers are possible since recipient coordinators can view relevant information before they receive an offer. With advance knowledge of a possible organ they can identify potential patients and check theatre and staff availability. Recipient Coordinators are able to decline in advance of an offer if they have no suitable recipients ensuring that offering is as efficient as possible because offers are made to centres who may have a match and the declining centre can stand down its team.

Faster organ offering contributes to minimising organ ischemic time (the time from when an organ loses a blood supply to the time when an organ regains a blood supply) thus maximising the likelihood of a successful transplant outcome.

The work/life balance of Recipient Coordinators is significantly improved. They are able to effectively access information from anywhere while on call and are able to proactively decline organs for which they would have no suitable recipients  thus avoiding urgent late night phone calls. Donor Coordinators achieve faster turnaround in donation reducing the number of very long work shifts. 

"We have been looking forward to the introduction of EOS and we are sure it will prove to be an invaluable tool in the organ offering process". 
Mr Nizar Yonan, Cardiothoracic Surgeon Wythenshawe Hospital, Manchester

EOS is Easy, Online and Saves Time".
E = Easy - Very simple to understand and to learn how to use.
O = Online - Can be used with 3G or Broadband, is secure and eliminates possible errors with multiple telephone calls.
S = Saves time -  No long telephone calls. Can view donor details in advance enabling quick decision making. 
Cardiothoracic Recipient Coordinators, Wythenshawe Hospital, Manchester

The ability to view potential donors prior to offering saves time and effort for the duty Office. Donor transplant coordinators and recipient coordinators and will enhance the service to recipients and cut down on allocation and offering time. 
Sally Norris & Jo Redfarn, DTCs Addenbrookes Hospital, Cambridge

Its a forum for accurate donor information sharing which will undoubtedly speed up the donation 
process. 
Lee Alexander/Dawn Lee DTCs Manchester Royal Infirmary, Manchester 

From the perspective of NHSBT and the donor and transplant professionals this project is immensely exciting and we feel it is a major step forward in the care of patients and their families involved in the truly altruistic process of organ donation. It will free up organ donor professionals to spend more time with donor families and assist in the optimisation of both quality and quantity of available organs for donation. 
Steve Bell, NHSBT Organ Donation & Transplantation Regional Manager.

"This is a very exciting development which will deliver a world class system for the offering of donated organs. It also has the potential for added functions such as entering tissue types which are used in a number of organ allocations, particularly kidneys." 
Sue Falvey, NHSBT's Director of Donor Care & Coordination

Donor Coordinators, as the primary users of the EOS system, are a dedicated, highly clinically trained group working in an extremely stressful environment. Often the Intensive Care Unit where a potential organ donor is located has little or no connectivitity so the ablity to enter information offline while caring for the patient is paramount to success. 
 
This capability was made possible by the innovative offline/online synchronisation scheme of EOS and the local Oracle Express database in the Donor Cooordinator laptops. Donor Coordinators now build a record of the potential donors medical history and condition then upload the information to the central National Transplant database to allow organ matching to take place. The synchronisation aspect comes into its own later as the Donor Coordinator continues to collect medical information. The NHSBT Duty Officer could have entered additional data, so Donor Coordinators maintain data accuracy and completeness because EOS identifies any inconsistencies between the data collected and in the central database and prompts the Donor Coordinator to correct it.

The number of disparate stakeholders involved in the end-to-end organ offering process posed a problem as the process spans multiple separately managed organisations. The requirements gathering phase of the project was particularly important because of this and all interested parties, including Donor Coordinators, Recipient Coordinators and surgeons. Delivering a common system across the UK through different organisations is a complex activity.

The culture change from completing a paper form to an electronic version proved to be significant. Training revealing a new mindset was required by the user. Although the benefits of an electronic means of recording information are fundamentally significant, it is a less forgiving method than paper. For example, the paper form allowed users to make notes "in the margin" so the web application had to be structured to provide extra free text areas for notes to be captured.

Although it can be used from a fixed location, users of the EOS system are generally mobile and using mobile technology. Users experienced some difficulties in coverage and bandwidth with the 3g mobile communications network. These were reasons why offline/online synchronisation was innovative along with the communications optimisation techniques used to maximise data throughput over the network.

 

Because of the significant step forward EOS makes in the organ offering process, there are few areas of resistance to adoption. Funding was in place as part of the wider organ donation task force transformation programme.

Achieved

The EOS application is currently being rolled out to further UK teams of Donor and Recipient Coordinators.

Another application called the Potential Donor Audit & Referral Database (PDA) is currently in development. This will enhance the collection of data from critical care areas with the objective of increasing the number of potential organ donors that actually become organ donors.

The PDA will make use of the same communications, hosting and offline/online/synchronisation mechanisms as EOS. PDA facilitates Donor Coordinators strategies to optimise organ donation quality and quantity. EOS has a remote upgrade capability that will be used for PDA, it enables significant changes in working practices, for example reducing unnecessary double data entry and the prevention of data entry errors which can be life threatening.

The EOS system has been well received by all teams. Since the users where so heavily involved in the development they feel ownership of the application. The networks signal coverage is not yet consistent across the country, but recent improvements have allowed connection from any computer with internet access.