Recommendations for Hosting a Virtual MDC
In order to transition from a traditional to a virtual MDC framework, we
suggest using the “Model for Improvement” created by the Associates in
Process Improvement23. This methodology entails a
cyclic four step process: plan, do, study, and act. This will help to
ensure the reliability and accuracy of a virtual MDC setup. Summarized
below are the corresponding sections for each process step.
- Virtual MDC Planning
The dedicated MDC organizer should meet with the institution’s IT
staff to brainstorm ideas for the virtual MDC. Questions to consider
include the cost of implementation, necessary IT infrastructure,
security measures, number of participants anticipated, feasibility,
ease of collaboration across MDT, and approximate timeline for
implementation. Once these essential topics are addressed and
discussed with MDT leadership, the organizer should proceed to hosting
a few trial MDC sessions in lieu of the weekly traditional meetings. A
simple survey addressing the ease of communication, participant
preferences, and comments may then be conducted. This will help to
gauge the degree of buy-in from MDT members at the onset of the
project. Based on the survey responses, we encourage discussion within
the MDT regarding the specific advantages and disadvantages to
implementing a virtual MDC. We anticipate that if there is a
significant preference for one format, there will be strong support
from MDT leadership to institute such a system.
- Virtual MDC Implementation
There are several factors which affect the degree to which MDT members
can interact in a virtual setting: time, ability to hear colleagues,
visualize case imaging, and see other MDT members24.
The organizer must find the best time to host the virtual MDC so that
as many MDC members can participate as possible. In addition, all MDT
members need adequate time to prepare for case discussions; thus, new
case submissions and the meeting agenda should be finalized at least a
day in advance permitting same-day case additions if needed. On the
matter of virtual MDC workflow in comparison to traditional meetings,
Kane and Luz found that teleconferencing was associated with a greater
time spent per case (147%), increased participant turn duration and
total attendance, decreased number of total participant turns per
minute and percent of informal conversation25.
Patients with advanced T and N staging will require more discussion
and time allocation as compared to those with early stage disease
whose treatment may be planned via a protocol26.
Thus, it would be beneficial to prioritize discussion of advanced
stage and complicated cases earlier in the teleconference when all
members are available.
Virtual MDC can be set up to allow either one or more MDT members to
talk at once. However, it is often the case that there is one MDT
member who has the floor at any given time while other participants
are muted in order to reduce background noise. In this way, the
speaker’s dialogue is easily understandable. Sometimes, in traditional
settings, there is risk of multiple people speaking at once or poor
voice projection across the room (i.e. room acoustics or variable
seating arrangements) that may make the meeting’s sound quality
inconsistent. With the virtual MDC, participants may have to wait a
bit longer to respond to discussions rather than speaking in freeform,
which would be the standard in traditional meetings. If the
teleconference connection quality is reliable, there should not be any
problems with MDT members hearing their colleagues.
We recommend a virtual MDC setup in which individual MDT members can
share their computer screen with others. In this manner, the MDT
radiologist should be able to access individual patient scans and
share them on a single centralized display. This tremendously improves
the ease of use for the radiology team. The radiologist can prepare
the pertinent imaging slides ahead of time and be ready to share this
information rather than having to reload all the images on a new
computer at the meeting hall. In a similar fashion, the pathologist
may be able to share the final pathology report, stains, or any
pertinent microscopy findings with the entire team. If there is any
need to verify case information, participants can check the electronic
medical record in real time as well. In terms of seeing other MDT
members, individuals can choose to utilize videoconferencing, but the
informal conversations in a traditional meeting are hard to replicate
in a virtual setting. If interested, MDT leadership may choose to hold
a once monthly or quarterly in-person meeting to support the team
camaraderie.
- Assessing Virtual MDC Performance
In order to evaluate the quality metrics of a virtual MDC, there must
be proper, systematic data collection. It is vital that each case
discussed at the MDC have documentation linked with the patient’s
electronic medical record. This information should be accessible to
all MDC participants in case specific members are unable to attend a
session. The documentation system should be design in a systematic
manner and be goal-oriented27. If data recording is
standardized, the MDC case database will serve as a central resource
for reviewing patient diagnostic pathways, treatment plans, outcomes,
and guideline adherence. This has immense implications for analyzing
patient data across the spectrum of care including survivorship. There
are a few options for building a virtual MDC documentation database.
Rangabashyam et al . utilized the REDCap web application,
Research Electronic Data Capture
(https://www.project-redcap.org/), in order to document each
aspect of MDC case presentation: scheduling, biodata, diagnosis,
presentation, imaging, histopathology, management plan, MDC
discussions and decisions28. This system proved to
be efficient as it could be embedded into the existing electronic
medical record system.
A few institutions have developed methods to independently assess MDC.
Harris et al . implemented an MDT meeting observational tool
(MDT-MOT); this rating system allowed observers to evaluate ten
different teamwork domains pertinent to the MDC and had good criterion
validity29. Virtual MDC can be assessed in terms of
process and outcome measures30. Process measures
include time interval to case presentation from initial request,
percentage of relevant member participation, and overall attendance.
Outcome measures include percentage of cases following MDC
recommendations, correlation of MDC recommendations with guidelines,
time to treatment initiation, disease-specific and overall survival,
and patient quality of life and satisfaction. Regardless of the
methodology in assessing virtual MDC, the underlying principle is to
have each institution critically review its own MDC and the outcomes
associated with its discussions.
- Process Modifications
Based on data analysis from the virtual MDC sessions, quality
improvement projects can be appropriately tailored. There are many
areas to focus on including preventing delays in treatment or
referrals and improving adherence to MDC recommendations. The
expectation is that each of these new quality improvement projects
will also follow the “plan, do, study, and act” process.
Furthermore, adjustments can be made to the virtual MDC setup if data
analysis shows that there is a specific area of weakness that can be
addressed.