DARA Platform – Pioneering Digital Solution for Comprehensive Care for Children with Cancer in Romania

Partner: Romanian Society of Pediatric Oncology and Hematology

Sponsors: ING Bank  and Vodafone Foundation România

DARA Platform is a digital solution that connects all specialists contributing to the care of children with cancer, usually they are not located in the same hospital, town or country. DARA offers them instant access to the full medical record of the patient and the possibility to collaborate efficiently in real time for the best treatment decisions and long term monitoring.

The transition from paper-based medical records to the digital format connects all parameters of an integrated quality care system for children with cancer in Romania.

Through the DARA platform, patients benefit from the creation of a comprehensive digital medical record, essential for providing new services: 

• Standardized multidisciplinary assessment through unlimited Tumor Board sessions, regardless of specialty and location (in-country and/or abroad)
• Consultation and real-time multidisciplinary intervention among the specialists required for each case.
• Access to remote intervention and monitoring services (between treatments and post-treatment) through real-time collaboration between the attending pediatric oncologist and healthcare providers in the local area (e.g., pediatricians, family doctors, etc.)
• Mobile monitoring services and specialized care at the patient’s home.
• Complex evaluation of therapy results using internationally standardized grids for quality of life, functional status, and treatment complications.
• Standardized provision and recording of second-opinion consultations, regardless of specialty and locationș
• A digital medical record containing the patient’s complete history, available in English as well, which can be instantly shared with doctors abroad
• The assessment of quality of life through internationally standardized grids. 

The purpose and objectives of DARA e-health platform

DARA is designed with the purpose of facilitating the care, monitoring, and multidisciplinary collaboration, as well as the collaboration between different levels of healthcare (tertiary level – specialized institutes and clinics, secondary level – clinics/hospitals in the community, primary level – family doctors/community services (home care)), having multiple modular, extensible functionalities.

The platform follows all stages of a case, from the process of diagnosis, treatment and monitoring, to long-term follow-up of patients.

It operates as a comprehensive electronic medical record, structuring the necessary information regarding the details of the case and the interventions performed on the patient, providing a complete and updated clinical picture in real-time.

Users

The users of the platform are all specialists within the multidisciplinary team, contributing to the integrated care of cancer patients, as well as all types of relevant medical service providers.

DARA has been piloted since April 2022 with over 60 doctors nurses involved in the care of hundreds of cases.

Hospitals currently using DARA for the care of children with cancer:

• Bucharest Oncology Institute
• Fundeni Clinical Institute
• “M.S. Curie” Children’s Hospital, Bucharest
• “Gr. Alexandrescu” Children’s Hospital, Bucharest
• “V. Gomoiu” Children’s Hospital, Bucharest
• Constanța County Emergency Hospital
• Brașov Children’s Hospital
• Sibiu Pediatric Hospital
• Galați Pediatric Hospital
• Ploiești Pediatric Hospital
• Rizzoli Orthopedic Institute, Bologna – Italy

Key functionalities

• Segregates access to patients’ medical data across different oncology departments through a complex system of roles
• Allows access to this data with different levels of access and unlocking specific functionalities according to competency levels:
  • Attending physician,
  • Central team (Tumor Board),
  • Local team (proximity care services team),
  • Home care team

• Allows structuring of the essential information regarding the oncological case – diagnostic details, staging, evolutionary status, and detailed information regarding the clinical interventions performed:

• • Imaging: Complex functionality that allows the patient’s imaging history to be stored unlimitedly in the Cloud, and to be analyzed comparatively or in evolution at any time.
  • Systemic Anti-neoplastic Therapy: details regarding the applied protocol, recorded in individual cycles, as well as capturing intentional deviations from the protocol with modern medications, in the joint effort to offer the patient the best chances.
  • Surgical Intervention: details regarding the procedures, the surgical protocol and outcomes, for curative and palliative purposes, as well as adjuvant or comorbidity treatment.
  • Radiotherapy: details regarding the type of radiotherapy, its application, dosage, and follow-up.
  • Pathological Anatomy and Cytology: details regarding the analyzed biopsies and observations made by specialists based on the analysis of samples, accompanied in an attachment by the entire anatomopathological report.
  • Transplantation: types of transplants performed, procedure details, recording conditioning elements, and subsequent immunosuppression according to standards.
  • Laboratory Tests: laboratory test results regardless of where they are collected, upon the specialist’s indication (from elements of hematology and biochemistry to advanced investigations such as specific tumor marker analysis and genetic and molecular testing).
  • Supportive and Non-Oncological Therapy
  • Hospital Presentations: information included in medical reports in an unstructured manner following hospitalizations, as well as structured information regarding the types of local treatments and classes of medication that can be administered, concerning the treatment of adverse effects, developed comorbidities, palliative care, etc., which can be performed in any hospital, upon the specialist’s indication.
  • Clinical (dynamic) Assessment – facilitates structured collection of clinical parameters and other parameters of interest monitored in the evolution of the disease.
  • Quality of Life: a standardized tool for assessing the quality of life and functional status of the patient, providing detailed information about the evolution of this parameter throughout the illness, as well as for comprehensive evaluation of treatment outcomes.
  • Home Care Module – allows coordination and recording of services provided locally/by home care providers, under the indication and remote supervision of the attending physician or any specialist in the multidisciplinary team.

• Provides the support for marking developed comorbidities as well as recording palliative treatments.
• Contains elements of an expert system that guides the physician according to the latest protocols and care standards, assisting them in making the best decisions regarding patient care.
• Provides a library of useful documents updated to modern international standards that can be instantly consulted to make the best medical decisions.
• The system is interoperable with cancer screening and population cancer registries, defining the case using the same syntax as the minimum dataset required for reporting to and from these registries.
• Allows the recording of the results and side effects of various treatments, serving as a valuable tool for analyzing their effectiveness and the nature of their side effects.
• Provides the virtual workspace for interdisciplinary collaboration:

• • Structured support for physical or virtual meetings of interdisciplinary committees for therapeutic indication in malignant tumors (Tumor Board) and for drafting conclusions and decisions made, in accordance with current regulations.
  • Module for communication and recording of inter-clinic consultations in any specialty / configuration.
  • The data collected enables the issuance of “second opinions”.
  • With bilingual features (RO and EN), the platform works across national boundaries, and enables international collaboration.

• The platform allows semi-automated planning of clinical interventions for each patient, ensuring an updated calendar. The entire medical team can access all information regarding the progression of a medical case, interventions performed up to that moment, and those planned for the future.
• The role and competency level system allows for unlimited configurations of specialties (individuals) and providers (institutions/organizations), sharing access to digital information from the platform, enabling uninterrupted and real-time monitoring by the case manager, while the patient is being cared for by other healthcare providers, under their remote supervision and guidance.

Auditability and Clinical Research

• Data import/export modules and reporting modules facilitate structured data collection and analysis for all types of clinical data, as well as operational performance analysis of services (evaluative research), and configuration of indicators of interest to be tracked in the reporting module.
• It automatically generates medical reports in a bilingual system and provides a comprehensive dashboard for attending physicians and specialty departments.

Basic Technical Aspects

• The platform has a three-tier modular architecture based on Service-oriented Architecture (SoA): modern web and mobile-compatible graphical interface in VueJS, SOLID back-end services in .NET/C#, and managed relational database – Azure SQL Server.
• The platform operates on the modern Microsoft Azure Cloud, ensuring high resilience and availability (24/7).
• The platform is easily scalable and extensible with new modules, supporting operation on large volumes of data and easy addition of new functionalities.
• The platform offers high cybersecurity standards, undergoing specific vulnerability analysis tests, penetration testing, anonymization, ensuring modern user authorization methods (two-factor authentication, role-based system, and access rights).